Association of COVID-19 Continuous Enrollment With Self-Reported Postpartum Medicaid Continuity and Coverage Inequities

Abstract

Objective: To examine the impact of extended postpartum Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) on self-reported postpartum insurance status among prenatal Medicaid recipients, and differences by state Medicaid expansion status and race, and ethnicity.

Study setting and design: We used a global polynomial linear regression discontinuity design (RDD) approach to estimate the effect of extended postpartum Medicaid eligibility during the FFCRA on changes in self-reported postpartum Medicaid, private coverage, and uninsurance. This approach compares individuals who gave birth before FFCRA exposure with those who gave birth during extended postpartum Medicaid eligibility, using birth timing to determine FFCRA exposure. We estimated RDD models overall, by state Medicaid expansion status, and by race and ethnicity.

Data sources and analytic sample: This study used 2018-2021 Pregnancy Risk Assessment Monitoring System data, a multi-state survey of individuals with a recent live birth, and a sample of prenatal Medicaid recipients age 20 or older in 29 study jurisdictions.

Principal findings: In adjusted RDD models, extended Medicaid eligibility was associated with a 10.7 percentage point (pp) (95% CI: 8.7, 12.6) increase in postpartum Medicaid, a 3.5 pp (95% CI: -5.2, -1.8) decrease in postpartum private coverage, and a 6.5 pp (95% CI: -8.0, -5.0) decrease in postpartum uninsurance. In stratified RDD models, we found larger increases in postpartum Medicaid and larger decreases in uninsurance in non-expansion states than in Medicaid expansion states. In RDD models by race and ethnicity, we found similar increases in postpartum Medicaid and similar decreases in postpartum uninsurance among non-Hispanic Black respondents, Hispanic respondents, and non-Hispanic White respondents.

Conclusions: We found significant improvements in postpartum Medicaid continuity and reductions in uninsurance during extended postpartum Medicaid eligibility. Postpartum Medicaid extensions under the American Rescue Plan could help maintain some coverage gains under the FFCRA.

Keywords: COVID‐19; Medicaid; health equity; health insurance; medically uninsured; postpartum period.

FIGURE 1

Monthly rates of postpartum insurance coverage before and during the FFCRA Medicaid continuous enrollment provisions, 2018–2021. Note: Author's analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) survey among respondents with Medicaid‐paid prenatal care in 29 jurisdictions, 2018–2021. n = 46,737, weighted N = 2,148,675. FFCRA is the Families First Coronavirus Response Act. The dashed line indicates the January 2020 cutoff for exposure to extended postpartum Medicaid eligibility.