Medicaid Expansion Tied to Reduced Postpartum Hospitalizations

Medicaid expansion was associated with a reduction in postpartum hospitalizations during the first six months after delivery, according to a Health Affairs study.

Federal policy requires Medicaid to cover services for pregnant people through 60 days postpartum. In states that expanded Medicaid under the Affordable Care Act (ACA), more low-income adults could receive coverage before pregnancy and following the 60-day postpartum period.

Researchers used data from 2010 to 2017 from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases to determine if the increased access to Medicaid coverage impacted rates of inpatient hospitalization during the first six months postpartum.

The analysis included data from four states that had adopted Medicaid expansion: Iowa, Maryland, New Mexico, and Washington, and four states that had not expanded Medicaid: Florida, Georgia, Mississippi, and Utah.

Before Medicaid expansion, the most common reasons for postpartum hospitalizations were complications of pregnancy, childbirth, and the puerperium; diseases of the digestive system; mental disorders; diseases of the genitourinary system; and injury and poisoning.

Pregnant people experienced reductions in hospitalizations after states expanded Medicaid, the study found. Meanwhile, postpartum hospitalizations increased for people in non-expansion states.

Before 2014, when states first had the option to expand Medicaid, the rate of postpartum hospitalizations was similar in expansion and non-expansion states.

After 2014, the rate of 60-day postpartum hospitalizations decreased by 0.289 percentage points in expansion states, indicating a 17 percent decrease from the baseline rate. Around 75 percent of this reduction was attributed to a decline in childbirth-related hospitalizations.

Medicaid expansion helped boost access to care and coverage before pregnancy, which may help people avoid or better manage conditions that could lead to postpartum hospitalizations, researchers noted.

The reduction in hospitalizations was slightly smaller between 61 days and six months postpartum, with the rate declining by 0.085 percentage points or 8 percent.

However, before Medicaid expansion, there were around 50 percent fewer hospitalizations overall during the 61 days to six months period compared to the 60-day postpartum period. In addition, only 8 percent of hospitalizations after 60 days were related to childbirth.

Although Medicaid expansion was associated with reduced postpartum hospitalizations for all racial and ethnic populations, the study highlighted racial disparities in postpartum readmissions. The rate of postpartum hospitalization through 60 days postpartum was 2.4 percent among non-Hispanic Black people compared to 1.7 percent for non-Hispanic White people and 1.5 percent for Hispanic people.

States can extend postpartum Medicaid coverage to 12 months after delivery under the American Rescue Plan Act. As of November 2022, 27 states and Washington, DC, have expanded this coverage.

Seven states that have implemented or are planning to implement this extension have not expanded Medicaid under the ACA.

“This study’s findings suggest that expanded coverage during the postpartum period in these states may lead to reductions in postpartum hospitalizations during the first six months after delivery,” researchers wrote.

In states that have extended postpartum coverage under ARPA, reductions in hospitalizations associated with Medicaid expansion may be more substantial.

“Future research focusing on a larger number of states, with sufficient power to examine the effects of these extensions on mental health and other common causes of pregnancy-related morbidity in the later postpartum period, is needed to determine the full effects of pregnancy Medicaid extensions,” the study concluded.

Medicaid covers more than 40 percent of all births in the country, putting the public payer in a key position to help prevent maternal uninsurance and reduce childbirth-related complications.

The study findings mirror research from October 2021, which found that Medicaid expansion was associated with increases in pre-pregnancy and postpartum insurance coverage. People in Medicaid expansion states were 22 percent more likely to have pre-pregnancy Medicaid coverage, and postpartum coverage increased by nine percentage points.