Preparing for the Postpartum Medicaid Extension Evaluation in Illinois

Abstract

Background: Given increased attention to the maternal health crisis, its heavy toll on Black birthing persons, and recognition that most pregnancy-related deaths occur in the extended postpartum period, Illinois implemented a Postpartum Medicaid Extension (PME). Objectives: The purpose of this study was to use baseline data from the pre-PME period to ascertain which groups of eligible persons can be expected to experience improved outcomes as a result of PME implementation in Illinois. Methods: We focused on the Well-Woman Visit (WWV) as it can be measured in the later postpartum period and is relevant for non-pregnant women. We provide baseline prevalence estimates for WWV receipt using PRAMS and BRFSS data within income strata and within combined income-insurance strata with particular attention to the income group most likely to be affected by the PME. Using multivariable binomial regression, we generate adjusted prevalence differences across income and insurance strata overall and by race/ethnicity. Results: The Illinois PME has the potential to improve the receipt of well-woman care in the 138-213% FPL income group, the group most likely to be affected by the PME. The analysis also suggests that Black women in Illinois may not be the group most likely to benefit from the enhanced access to care made available by the PME without additional focused attention to their particular needs and experiences. Conclusions and Implications for Practice and Policy: The PME is necessary but not sufficient for addressing racial/ethnic inequities in maternal health. Leveraging the opportunity that the PME provides to design and support delivery models that maximize the effects of such coverage will be essential to address the maternal health crisis in Illinois. Without extra attention to the needs and experiences of Black women, focused on the delivery of care as well as the structural determinants of health including institutional and interpersonal racism, the benefits of the PME for Black women may not be fully realized.