Impact of Medicaid Enrollment Provisions on Postpartum Coverage and Resource Use in Three US States
Author(s)
Madhav KC, PhD1, Meghana Shamsunder, MPH1, Michael J. Munsell, PhD2;
1Panalgo, Boston, MA, USA, 2Panalgo, Director of Research, Boston, MA, USA
1Panalgo, Boston, MA, USA, 2Panalgo, Director of Research, Boston, MA, USA
Presentation Documents
OBJECTIVES: To explore changes in postpartum Medicaid coverage and resource use following two federal provisions that expanded eligibility in three US states.
METHODS: Medicaid financed live births from 1/1/2018-12/31/2023 with a Georgia, Florida, or South Carolina state of residence at the time of delivery were identified in a dataset that includes administrative claims data for 3 million mother-infant pairs. The proportion of mothers with at least six months continuous postpartum coverage was evaluated for three time periods: 1) pre-COVID-19 public health emergency (when each included state had a 60-day postpartum coverage limit for those eligible through pregnancy alone), 2) birth during Families First Coronavirus Response Act (FFCRA, which prohibited Medicaid termination), 3) birth occurring after state-specific adoption of American Rescue Plan Act (ARPA, federal matching funds available for postpartum coverage expansion). For those with at least six months postpartum coverage, baseline comorbidities and postpartum resource use occurring between 60 days and six months following childbirth was evaluated and compared between pre-COVID and ARPA adoption time periods.
RESULTS: 96,025 pregnancy episodes were identified (40% pre-COVID-19, 39% FFCRA, 21% ARPA). The proportion of mothers with at least six months postpartum coverage increased from 41.05% pre-COVID-19 to 95.34% and 95.63% during FFCRA and ARPA, respectively. Compared with pre-COVID-19, pregnancy episodes following ARPA adoption had fewer office visits (1.95 vs. 2.90, p<0.01) and a similar rate of hospitalization (1.00% vs. 1.17%, p=0.12). A higher proportion of ARPA pregnancy episodes had pre-existing obesity (26.51% vs. 24.92%, p<0.01), however, fewer had hypertensive heart disease (10.31% vs. 11.43%, p<0.01) and type 2 diabetes mellitus (1.88% vs. 2.25%, p=0.02).
CONCLUSIONS: States that extended pregnancy-related Medicaid eligibility postpartum experienced a substantial gain in coverage continuity. Further research is needed to determine whether an observed decrease in preventative resource utilization following ARPA adoption is due to population-level clinical differences or unmeasured barriers to access.
METHODS: Medicaid financed live births from 1/1/2018-12/31/2023 with a Georgia, Florida, or South Carolina state of residence at the time of delivery were identified in a dataset that includes administrative claims data for 3 million mother-infant pairs. The proportion of mothers with at least six months continuous postpartum coverage was evaluated for three time periods: 1) pre-COVID-19 public health emergency (when each included state had a 60-day postpartum coverage limit for those eligible through pregnancy alone), 2) birth during Families First Coronavirus Response Act (FFCRA, which prohibited Medicaid termination), 3) birth occurring after state-specific adoption of American Rescue Plan Act (ARPA, federal matching funds available for postpartum coverage expansion). For those with at least six months postpartum coverage, baseline comorbidities and postpartum resource use occurring between 60 days and six months following childbirth was evaluated and compared between pre-COVID and ARPA adoption time periods.
RESULTS: 96,025 pregnancy episodes were identified (40% pre-COVID-19, 39% FFCRA, 21% ARPA). The proportion of mothers with at least six months postpartum coverage increased from 41.05% pre-COVID-19 to 95.34% and 95.63% during FFCRA and ARPA, respectively. Compared with pre-COVID-19, pregnancy episodes following ARPA adoption had fewer office visits (1.95 vs. 2.90, p<0.01) and a similar rate of hospitalization (1.00% vs. 1.17%, p=0.12). A higher proportion of ARPA pregnancy episodes had pre-existing obesity (26.51% vs. 24.92%, p<0.01), however, fewer had hypertensive heart disease (10.31% vs. 11.43%, p<0.01) and type 2 diabetes mellitus (1.88% vs. 2.25%, p=0.02).
CONCLUSIONS: States that extended pregnancy-related Medicaid eligibility postpartum experienced a substantial gain in coverage continuity. Further research is needed to determine whether an observed decrease in preventative resource utilization following ARPA adoption is due to population-level clinical differences or unmeasured barriers to access.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P54
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care
Disease
SDC: Reproductive & Sexual Health