The Impact of Medicaid Expansion on Postpartum Health Care Utilization among Pregnant Women with Opioid use Disorder

Abstract

Background: Opioid use disorder (OUD) during pregnancy has increased dramatically over the past decade, as have associated adverse maternal health outcomes. Although Medicaid has long been the largest payer for deliveries in the United States, states' decisions to expand Medicaid eligibility to low-income adults has the potential to increase access to care for women in the postpartum period. This study aimed to determine the impact of the 2015 Pennsylvania Medicaid expansion on postpartum insurance coverage and preventive care utilization among pregnant women with opioid use disorder (OUD). Methods: In 2017, we conducted a retrospective cohort study using 2013-2015 administrative Medicaid data provided by the Pennsylvania Department of Human Services. We identified 1562 women with opioid use disorder who had a live birth delivery in a pre-Medicaid expansion or postexpansion study period. We compared length of continuous enrollment in Medicaid following delivery, postpartum visit attendance, and contraception initiation between groups. Results: More women in the post-expansion group remained enrolled in Medicaid at 300 days postpartum, relative to the pre-expansion group (87% vs. 81%). Medicaid expansion was not associated with differences in postpartum visit attendance or contraceptive use. However, women who remained enrolled in Medicaid for at least 300 days post delivery had an increased odds of postpartum visit attendance (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.04, 2.4).

Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure

“…6,34 Overall, only one in five women with infants affected by substance exposure attended a postpartum visit within 60 days of delivery, which is consistent with a 2019 study of women with OUD in a single state. 35 Contrary to our expectations, there was no significant difference between receipt of postpartum SUD treatment and attendance at the postpartum visit. This lack of an association is concerning; ideally, the postpartum visit should be an opportunity to ensure appropriate linkage to SUD treatment during this vulnerable period as well as to address prevalent co-occurring mental health conditions that, consistent with other literature, 10,[36][37][38] were common in our study sample.…”

Association of Medicaid Expansion Under the Affordable Care Act With Perinatal Care Access and Utilization Among Low-Income Women

“…13,16 For the meta-analysis, one study was excluded due to the previously mentioned study design incompatibility 16 and two studies were excluded due to difficulty interpreting the outcome metrics in pooled analysis. 17,19 Effect estimates showed a presence of significant heterogeneity (Q statistic5321.46, df54, P,.01; I 2 597.14). Random effects modeling based on pooled data from the five included studies indicates that Medicaid expansion under the ACA was associated with a Unauthorized reproduction of this article is prohibited.…”

Factors associated with contraceptive use among postpartum women with substance use disorder

“…42 Another study analyzing the impact of the 2015 Pennsylvania Medicaid expansion on preventive care utilization found that women who remained enrolled in Medicaid at least 300-days post-delivery had an increased odds of attending their postpartum care visit. 43 One way that this can be interpreted is that by expanding insurance coverage, access to healthcare visits improves therefore increasing the opportunity to implement appropriate reproductive counseling and services in the postpartum population.…”