“Studies have shown that the postpartum period is generally a time of increased insurance instability, primarily because individuals [with] Pregnancy-related Medicaid coverage loses eligibility after 60 days postpartum,” said lead researcher Erica Eliason, PhD, postdoctoral fellow in health services, policy, and practice at Brown University School of Public Health in Providence, Rhode Island. “As a result, individuals must be eligible for parental Medicaid to maintain Medicaid coverage beyond this period, which has more restrictive income eligibility, or find other insurance options.”
According to Eliason, the change in insurance eligibility results in high uninsurance during the postpartum period for those who had pregnancy-related Medicaid coverage. “However, to promote access to insurance during the COVID-19 public health emergency, there was a Medicaid policy change that froze opt-out, meaning anyone who was going to lose eligibility to Medicaid no longer did.”
Pandemic Medicaid policy inspired the authors to examine changes in Medicaid eligibility after childbirth, “which has recently generated political interest at the state and national level,” Eliason said. Contemporary OB/GYN®.
Investigators selected data from the Current Population Survey 2019 to 2021, Annual Social and Economic Supplement. (Among the 4,448 postpartum respondents, the transition from insured to uninsured decreased by 1.3%, from 3.1% in 2019 (before the pandemic) to 1.8% during the pandemic in 2021. The results indicated no other significant changes in coverage overall.1
In 2019, 88.2% of postpartum respondents with Medicaid the previous year had consistent Medicaid coverage, while 10.3% lost coverage and 1.6% switched to private coverage.
In 2021, constant Medicaid coverage increased 6.8% and non-Medicaid churn decreased 6.6%, representing a 64% decline from 2019.
In 2019, 97.1% of all postpartum respondents with private coverage in the past year also maintained constant private coverage, while 1.4% had private rollover with Medicaid and 1.3% had lost their cover.
Compared to 2019, private Medicaid churn increased by 1.5% in 2021.
“The results were largely what we expected,” Eliason said. “Although the pandemic policy was not specific to promoting postpartum Medicaid, we anticipated that there would be improvements in postpartum Medicaid because so many people were losing their Medicaid coverage during this period before policy change.”
Eliason noted that increasing continued postpartum coverage should provide better access to postpartum care, “but this policy shift happened during the pandemic, which other research suggests led to a reduction in health care utilization, so he might not have achieved the same improvements in postpartum access to care that would have occurred without the pandemic,” he said. she declared.
“People may not have known they were staying insured and therefore may not have seen improved access to postpartum care,” Eliason said.
Medicaid’s pandemic policy change continues to be extended, but is currently set to expire in July 2022. “When this policy is lifted, postpartum individuals whose pregnancy-related Medicaid coverage was going to end after 60 days after childbirth will lose that Medicaid coverage.” Eliason said, “and we ‘could see a lot of people who had stable Medicaid during the pandemic suddenly uninsured.’
- [ PubMed ]Eliason EL, Daw JR, Steenland MW. Changes in postpartum insurance coverage in the United States during the COVID-19 pandemic. JAMA Health Forum. Published online April 22, 2022. doi:10.1001/jamahealthforum.2022.0688