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abstract Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Medicaid enrollees are at higher risk of postpartum disruptions in insurance because pregnancy-related Medicaid eligibility ends sixty days after delivery. We used Medicaid claims data for 2013-15 from Colorado, which expanded Medicaid under the Affordable care Act, and Utah, which did not. We found that after expansion, new mothers in Utah experienced higher rates of Medicaid coverage loss and accessed fewer Medicaid-financed outpatient visits during the six months postpartum, relative to their counterparts in Colorado. The effects of Medicaid expansion on postpartum Medicaid enrollment and outpatient utilization were largest among women who experienced significant maternal morbidity at delivery. These findings provide evidence that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
The United States has the highest maternal mortality rate in the developed world.1 Maternal morbidity and mortality occur at higher rates among low-income women in minority racial/ethnic groups, who also disproportionately receive maternity care through the Medicaid program.2,3 Although one-third of pregnancy-related mortality in the US occurs after delivery,4 only 40 percent of women enrolled in Medicaid receive a postpartum follow-up visit.5 Women who do not receive postpartum care are at higher risk for undiagnosed complications of pregnancy, delayed initiation of contraception, and unaddressed infant care issues.6,7
Medicaid eligibility criteria create barriers to accessing postpartum care. Under current Medicaid policy, pregnant women are eligible for Medicaid coverage from conception through sixty days after delivery. After that time, women can remain enrolled in Medicaid only if they qualify for parental Medicaid coverage. Income thresholds for that coverage vary by state but are considerably lower than those for pregnancy coverage, particularly in states that did not expand eligibility for Medicaid coverage under the Affordable Care Act (ACA). As of June 2018, among the seventeen states that did not expand Medicaid, the median parental income cutoff was 43 percent of the federal poverty level, and the median pregnancy income cutoff was 200 percent of poverty.8 This eligibility cliff between pregnancy and parental coverage can lead to gaps in insurance coverage. Jamie Daw and coauthors found that before the ACA, 55 percent...