Medicaid expansion improves access to postpartum care

Study comparing Utah and Colorado finds Medicaid expansion helped prevent new mothers from losing coverage to the "postpartum coverage cliff," with implications for reducing maternal mortality.

A new study led by a Boston University School of Public Health (BUSPH) researcher finds that new mothers in a state that expanded Medicaid (Colorado) were more likely to keep Medicaid coverage and access postpartum care than those in a similar state that had not yet expanded Medicaid (Utah). The study, published in the journal Health Affairs, found that this was especially true for new mothers who had experienced pregnancy/childbirth complications.

"One third of maternal mortality occurs after delivery, so continuous access to care in the year after birth is critical," says study lead author Dr. Sarah Gordon, assistant professor of health law, policy & management at BUSPH.

Medicaid policies in many states create a postpartum coverage "cliff," she explains: "Medicaid eligibility for pregnancy ends just 60 days after delivery, and income limits for parental Medicaid coverage typically fall far below income limits for pregnancy Medicaid coverage, resulting in high rates of postpartum coverage loss." Medicaid expansion can narrow that gap.

For the study, Dr. Gordon and colleagues analyzed 2013-2015 Medicaid claims data from Colorado (which expanded Medicaid in January 2014) and Utah (which would go on to expand Medicaid in 2019). The researchers found that Colorado and Utah had similar trends in 2013, but, after Colorado expanded Medicaid, new mothers in Colorado kept their Medicaid coverage for an average of one month longer than new mothers in Utah. New mothers in Colorado also had 0.52 more Medicaid-financed outpatient visits in the six months after delivery on average than in Utah. Among new mothers who had severe complications at the time of childbirth, Medicaid-financed outpatient visits nearly tripled in Colorado after expansion, and were 50 percent higher in post-expansion Colorado than in Utah.

The researchers found that Medicaid enrollment actually declined among new mothers in Utah during the observed period, while they held steady in Colorado, possibly because the Affordable Care Act made private insurance more accessible. However, after incorporating available data from these private plans, the researcher found only a very small reduction in the difference in the states' rates of coverage and postpartum care utilization.

The study shows that Utah's recent ballot-led Medicaid expansion will likely help new mothers in the state, Dr. Gordon says, and adds to the evidence behind other pushes to narrow the gap: "Eight states and Washington, D.C. have introduced laws or regulations to extend postpartum coverage, and national legislation currently advancing through the House would give states the option to do so," she says.