Continuous Medicaid eligibility during PHE improved postpartum coverage

The continuous Medicaid eligibility requirement during the COVID-19 public health emergency was associated with increased postpartum Medicaid enrollment and reduced uninsurance, according to a study published in JAMA Health Forum.

Health insurance can help ensure access to physical and mental healthcare after childbirth. Federal law requires all states to provide Medicaid to low-income people from conception to 60 days after delivery. Many states have expanded this coverage period to 12 months after birth under the American Rescue Plan Act (ARPA).

During the COVID-19 pandemic, the 2020 Families First Coronavirus Response Act (FFCRA) prevented states from disenrolling Medicaid beneficiaries, which helped extend pregnancy-related Medicaid eligibility.

Researchers used 2017 to 2021 data from the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) to determine the association of continuous Medicaid eligibility under FFCRA with postpartum health insurance, postpartum visit attendance, contraception, breastfeeding, and depressive symptoms.

The study sample included 47,716 people with a birth paid for by Medicaid. Continued enrollment in Medicaid postpartum increased from 63.1 percent in the pre-policy period (2017 to 2019) to 72.8 percent in the post-policy period (2020 to 2021). Postpartum uninsurance declined from 16.7 percent to 9.6 percent over the same time.

Postpartum visit attendance, effective contraception, long-acting reversible contraceptive use, and depressive symptoms decreased in the post-policy period, while breastfeeding did not change.

A 100 percent federal poverty level increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point increase in postpartum Medicaid coverage, no change in commercial coverage, and a 6.6 percentage point reduction in uninsurance.

These findings suggest that extending Medicaid eligibility through the first year after delivery is likely to improve postpartum coverage. States that adopt the ARPA extension will continue to see reduced levels of postpartum uninsurance, researchers theorized.

Postpartum uninsurance during the pandemic may have been partially attributed to a lack of beneficiary awareness of continued Medicaid coverage.

“States that are currently implementing post-pandemic postpartum Medicaid extensions should invest in insurance navigators, enrollee outreach, and communication strategies to ensure beneficiary awareness of continued coverage and the benefits available in the postpartum year,” researchers wrote. “Efforts may also be needed to ensure enrollees maintain Medicaid coverage if eligible, or switch to an affordable commercial plan, when pregnancy Medicaid coverage is terminated at one year after birth.”

Regarding the minimal effects on contraception and depressive symptoms, the study noted that quarantine or potential fears of being exposed to COVID-19 may have limited postpartum visits, which often address contraception and mental health.