More people had stable access to Medicaid coverage in the year after giving birth during the COVID-19 pandemic, which suggests that the Families First Coronavirus Response Act’s Medicaid continuous coverage provision, which linked receipt of enhanced federal Medicaid and CHIP funding to a prohibition on involuntary disenrollment from Medicaid during the COVID-19 public health emergency, led to “substantial reductions in postpartum coverage loss,” according to a new study published in JAMA Health Forum.
The authors argue that extending Medicaid postpartum coverage to one year after the end of pregnancy—as more than half the states will do under the American Rescue Plan state option and as mandated in the House-passed Build Back Better Act—is necessary to maintain these pandemic-era gains in postpartum insurance continuity.
The findings build on recently-released Medicaid enrollment data from CMS which showed that the pregnancy eligibility category saw the greatest percentage increase of any group from February 2020 to August 2021. Both the data and the study findings indicate that the continuous enrollment protection is filling a coverage gap for postpartum people.
The JAMA Health Form study’s authors examined changes in postpartum “insurance churn”—or insurance loss or changes in insurance type during the previous year— between 2019 and 2021 to determine the effects of the pandemic on postpartum coverage.
Before the pandemic coverage protections took effect in March 2020, coverage in Medicaid ended just 60 days after the end of pregnancy, leaving new mothers without access to medications or health care services at a critical time. About 45 percent of women covered by Medicaid and CHIP for pregnancy become uninsured when the coverage ends at 60 days postpartum, a previous estimate by the Congressional Budget Office found.
About one third of pregnancy-related deaths occur between one week and one year after the end of the pregnancy, and as state maternal mortality review committees in dozens of states have shown, these deaths are often preventable. This suggests that improving access to care during this critical period and extending postpartum Medicaid health coverage could be lifesaving for new mothers.
Authors Erica Eliason and Maria Steenland from Brown University and Jamie Daw of Columbia University analyzed survey response data from the 2019 to 2021 Current Population Survey, Annual Social and Economic Supplement (CPS-ASEC) to include female respondents aged 18 to 44 years who were living with a child younger than 1 year, and who reported coverage both at the time of the survey (i.e., within 1 year postpartum) and during the last calendar year (i.e., the likely payer for pregnancy/birth).
The authors found that, in 2019 (before the pandemic), among postpartum respondents with Medicaid during the last year, 88.2 percent had consistent Medicaid, 10.3 percent lost coverage, and 1.6 percent switched to private coverage. By 2021, however, consistent Medicaid increased by 6.8 percentage points to about 95 percent of postpartum respondents maintaining consistent Medicaid coverage during the previous year. Researchers also found that Medicaid-to-uninsured churn decreased by 6.6 percentage points—from 10.3 percent in 2019 to 3.7 percent in 2021—representing a 64 percent decline.
Consistent private coverage among postpartum people dropped from 97.1% to 95.6% between 2019 and 2020. However, there was only a small increase in the uninsured rate. Transitions from private insurance to Medicaid increased from 1.4% to 2.9%, suggesting that private coverage declines during the pandemic were largely offset by increases in Medicaid coverage.
Medicaid has filled a critical gap for pregnant women and new mothers during the pandemic, and the disenrollment freeze is essentially functioning as a proxy for what would happen if the whole country extended postpartum Medicaid coverage to at least 12 months after the end of pregnancy. These research findings show the benefits of extending postpartum Medicaid beyond its current cutoff of 60 days after the end of the pregnancy, and the risks of going back to pre-pandemic policies where women lost postpartum coverage just two months after delivery.
