During the first month of the COVID-19 pandemic in the United States, the Families First Coronavirus Response Act (FFCRA) prevented Medicaid programs from disenrolling people during the public health emergency. For the first time in history, Medicaid-enrolled postpartum mothers were allowed insurance for more than 60 days past birth.
This policy change, and other extensions to Medicaid made in 2021, led to a 40% decline in postpartum lack of insurance, according to a new study in JAMA Health Forum.
The authors suggest that increasing maternal insurance coverage in the postpartum year is a strong first step to fighting increasing US maternal death rates, which are high compared to other Western countries.
"A lot of postpartum maternal deaths are occurring in the late postpartum period, or beyond 43 days postpartum, which is actually around the time Medicaid coverage has historically ended." said senior author Lindsay Admon, MD, in a press release from the University of Michigan.
A lot of postpartum maternal deaths are occurring in the late postpartum period, or beyond 43 days postpartum.
Largest improvement in Black women
The study compared outcomes among 47,716 participants who had a Medicaid-paid birth in 21 states with continuous pre-policy (2017 to 2019) and post-policy (2020 and 2021) participation in the Pregnancy Risk Assessment Monitoring System.
Participants were 18.9% Hispanic, 26.2% Black, 36.3% White, and 18.6% of other race or ethnicity, and 64.4% were under the age of 30. Outcomes assessed included health insurance, contraceptive use, breastfeeding, and postpartum depression.
The authors found that the FFCRA was associated with an 8% increase in postpartum Medicaid coverage and a 40% reduction in being uninsured among those with a Medicaid-paid birth, but was not associated with other outcomes. From baseline, lack of insurance decreased among Black and White people with Medicaid-paid births by 96.9% and 69.3%, respectively.
"These findings suggest that policies extending Medicaid eligibility through the first year postpartum are likely to achieve the first-order goal of improving postpartum coverage," the authors concluded.