Medicaid expansion resulted in decreased postpartum hospitalizations
The results provide evidence that Medicaid expansion is beneficial for the health of those who have just given birth.
Photo: Jose Luis Pelaez Inc/Getty Images
Medicaid expansion appears to be a boon to the Biden administration's push to improve maternal health, with a 17% decline in postpartum hospitalizations in states that elected to expand the federal program.
The results, published in Health Affairs, showed this reduction in hospitalizations held for the first 60 days postpartum, and there was some evidence of a smaller decrease in hospitalizations between 61 days and six months postpartum.
Since hospitalizations are evidence of health issues that exacerbate to the point of requiring an inpatient hospital stay, the results provide evidence that Medicaid expansion is beneficial for the health of those who have just given birth, the authors said.
WHAT'S THE IMPACT?
Medicaid provides health insurance for low-income Americans, and in states that expanded it, new eligibility rules under the Affordable Care Act allowed for a greater proportion of low-income adults to qualify for coverage both before pregnancy and after a 60-day postpartum period.
That in turn resulted in notable increases in Medicaid enrollment and overall insurance coverage, both before and after pregnancy. Low-income parents also saw greater continuity in their insurance coverage.
Prior to the ACA-enabled expansions, pregnant Medicaid patients could keep their coverage for 60 days after giving birth. But without the expansion, Medicaid coverage ended after that 60-day period.
The researchers compared changes in hospitalizations among low-income patients with a Medicaid-financed delivery in states that did, and did not, expand Medicaid under the ACA, for six months after giving birth. The four expansion states included Iowa, Maryland, New Mexico and Washington; the four non-expansion states were Florida, Georgia, Mississippi and Utah. The data came from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Inpatient Databases.
In their analysis, the researchers found similar trends in postpartum hospitalizations among new parents in the two groups of states before the ACA Medicaid expansions.
Starting at the time of Medicaid expansion, the relative trend in hospitalizations within 60 days postpartum decreased in expansion states compared with non-expansion states. The researchers found a 17% reduction in hospitalizations during the first 60 days postpartum associated with the Medicaid expansions. About 75% of this decline can be attributed to a decrease in childbirth-related hospitalizations.
They found some evidence of a decrease in postpartum hospitalizations after 60 days, but because hospitalizations during this time period tend to be rare, the sample size was too small to draw conclusions.
The researchers said that, moving forward, they are interested in examining how state policies extending Medicaid pregnancy coverage through the first year after giving birth will impact not only a person's health, but also other aspects of their lives, including their mental health and financial status.
THE LARGER TREND
More than half of all states across the country have expanded access to 12 months of Medicaid and Children's Health Insurance Program coverage after pregnancy, the Department of Health and Human Services said in October.
Georgia and Pennsylvania are the 25th and 26th states to be approved for the extended coverage, made possible by provisions in the American Rescue Plan signed into law by President Biden in March 2021.
It's estimated that up to an additional 57,000 people in those two states will now be eligible for Medicaid or CHIP for a full year after pregnancy. In total, an estimated 418,000 Americans across 26 states and Washington D.C. now have expanded access to postpartum coverage.
Extending Medicaid and CHIP coverage is part of CMS' Maternity Care Action Plan, announced in July 2022. CMS said it's also working to expand its data collection efforts, build a better understanding of key demographic drivers of health to identify disparities in care or outcomes, and coordinate across programs to identify gaps and best practices.
CMS said it will also engage with states, providers and other stakeholders to improve maternal care among Medicaid, CHIP, Medicare and Health Insurance Marketplace enrollees. It will also work with states and sister agencies to expand and improve access to the maternity care workforce, including midwives and community-based practitioners such as doulas and community health workers.
About 18 million Medicaid beneficiaries are expected to lose their continuous coverage as states start the redetermination process on April 1.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
