Postpartum Medicaid Use in Birthing Parents and Access to Financed Care

Abstract

Importance: The American Rescue Plan of 2021 allowed states to expand pregnancy Medicaid coverage to 12 months post partum. How the new policy affects Medicaid coverage and health care utilization is largely unknown.

Objectives: To quantify insurance coverage and care utilization for postpartum individuals under Medicaid policies that extended postpartum coverage to 12 months after delivery from 60 days.

Design, setting, and participants: A retrospective study of Medicaid coverage and utilization in North Carolina using Medicaid claims from March 2016 to December 2023 was conducted. All Medicaid-funded births in North Carolina from January 2017 through December 2022 were included.

Exposure: A total of 3 periods were differentiated: before the COVID-19 public health emergency (PHE), during the PHE when there was a moratorium on Medicaid disenrollment, and after North Carolina adopted the 12-month postpartum extension through the American Rescue Plan of 2021.

Main outcomes and measures: Length and type of postpartum Medicaid enrollment were evaluated. Utilization outcomes included indicators of (1) the receipt of at least 1 postpartum visit; (2) any contraceptive visit; (3) any primary care visit; (4) any outpatient mental health care, and (5) any outpatient substance use disorder (SUD) care.

Results: There were 353 957 Medicaid-funded births in North Carolina from January 2017 through December 2022. During the postpartum extension, Medicaid recipients were more likely to have been continuously covered by comprehensive Medicaid at 12 months post partum (97.1% vs 26.5% pre-PHE). Beneficiaries in the extended coverage cohorts were substantially more likely to use Medicaid-financed care than those in the pre-PHE cohort for contraception (47.8% for the PHE cohort and 47.9% for the extension cohort vs 38.0% for the pre-PHE cohort), primary care (68.1% for the PHE cohort and 71.4% for the extension cohort vs 25.3% for the pre-PHE cohort), mental health (22.1% for the PHE cohort and 25.7% for the extension cohort vs 7.5% for the pre-PHE cohort) and substance use disorder visits (3.6% for the PHE cohort and 5.3% for the extension cohort vs 2.2%for the pre-PHE cohort) within 12 months, although there was evidence of delays in early postpartum and contraceptive visits.

Conclusions and relevance: Results of this study suggest that extending Medicaid coverage for 12 months post partum was associated with expanded opportunities for greater access to Medicaid-financed medical and behavioral health care. Both prevention and ongoing treatment of chronic conditions may help mitigate key adverse outcomes. Findings may help policymakers and public health officials understand how extended coverage affects access to Medicaid-financed care.

Figure.. Coverage in the First Year Post Partum Among North Carolina Medicaid for Pregnant Women (MPW) Recipients by Policy Period (2017 Through 2022)

Among deliveries to people with North Carolina MPW, coverage type at 3 postpartum time points is depicted. Policy periods are stratified as pre–COVID-19 public health emergency (pre-PHE), during the COVID-19 public health emergency (PHE), and after implementation of the 12-month postpartum extension (extension).