Medicaid Expansion Increased Preventive Care for Pregnant and Postpartum Women, New Study Finds

Medicaid expansion increased the use of key preventive health services by women before and after pregnancy, a new study published in Health Affairs found. The findings add to the evidence that expanding Medicaid coverage to all low-income adults does translate into more utilization of preventive care that can improve the health and wellbeing of women before, during and after pregnancy, and supports the healthy development of parents and children together.

Looking at the period of 2011 and 2018, the authors selected six indicators from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), which collects information on respondent’s health risks and chronic health conditions, and four indicators from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), which collects information through interviews on women’s experiences before, during and after pregnancy.

They found that there was a significant increase in the share of women in Medicaid expansion states reporting a preconception health conversation with a provider before pregnancy (22% increase), taking daily folic acid supplements (which can reduce the risk of certain birth defects) in the month before pregnancy (10% increase), and the use of effective contraception during the postpartum period (7% increase), compared to women in states that had not expanded Medicaid by the end of 2018. The other seven indicators did not change significantly during the study period.

Importantly, while the study’s overall results show that Medicaid expansion was only significantly associated with improvements in three out of the ten indicators, all three (preconception counseling, folic acid intake, and postpartum contraception) were from the PRAMS data, rather than from the BRFSS data.

This seems to show that Medicaid expansion has been successful at improving uptake of specific health behaviors surrounding low-income women’s pregnancies (measured by PRAMS), even if it hasn’t significantly improved other risky behaviors or chronic conditions among low-income women of reproductive age more generally (measured by BRFSS). As the authors argue in the discussion, the data are only five years out from expansion and it may simply take more time for improvements in chronic conditions to appear statistically significant.

The study also underscores the need for consistent coverage before, during and after pregnancy to help women address health risks and chronic conditions more broadly. For instance, some of the leading causes of maternal mortality are cardiovascular conditions, which are often the result of years of health and social challenges and cannot be managed by just a few months of prenatal care alone.

The authors also point to Medicaid expansion’s role in increasing access to postpartum care for women in the expansion group after the end of their pregnancy.  They also highlight national and state level efforts to extend Medicaid postpartum coverage from 60 days to one year after the end of the pregnancy as a way to ensure that low-income women receive the postpartum and interconception care they need to ensure their own health and the health of any subsequent pregnancies and births.

Expanding Medicaid coverage to all adults has been proven over and over again to improve access and use of care by newly insured adults. For people who may become pregnant, consistent coverage before, during and after pregnancy is essential to making sure they have a healthy pregnancy and birth, and have access to the preventive health care and support to ensure their new child’s healthy development as well.