Not all Medicaid for pregnancy care is delivered equally

Author:

Swartz Jonas J.ORCID,Kaufman MenollyORCID,Rodriguez Maria I.

Abstract

Objectives Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the preconception and postpartum periods. Pregnancy Medicaid has higher income limits for eligibility than traditional Medicaid but only provides coverage during and for a limited time period after pregnancy. Our objective was to determine the association between type of Medicaid (traditional Medicaid and pregnancy Medicaid) on receipt of outpatient care during the perinatal period. Methods This retrospective cohort study compared outpatient visits using linked birth certificate and Medicaid claims from all Medicaid births in Oregon and South Carolina from 2014 through 2019. Pregnancy Medicaid ended 60 days postpartum during the study. Our primary outcome was average number of outpatient visits per 100 beneficiaries each month during three perinatal time points: preconceputally (three months prior to conception), prenatally (9 months prior to birthdate) and postpartum (from birth to 12 months). Results Among 105,808 Medicaid-covered births in Oregon and 141,385 births in South Carolina, pregnancy Medicaid was the most prevelant categorical eligibility. Traditional Medicaid recipients had a higher average number of preconception, prenatal and postpartum visits as compared to those in pregnancy Medicaid. Discussion In South Carolina, those using traditional Medicaid had 450% more preconception visits and 70% more postpartum visits compared with pregnancy Medicaid. In Oregon, those using traditional Medicaid had 200% more preconception visits and 29% more postpartum visits than individuals using pregnancy Medicaid. Lack of coverage in both the preconception and postpartum period deprive women of adequate opportunities to access health care or contraception. Changes to pregnancy Medicaid, including extended postpartum coverage through the American Rescue Plan Act of 2021, may facilitate better continuity of care.

Funder

National Institute on Minority Health and Health Disparities

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Publisher

Public Library of Science (PLoS)

Reference18 articles.

1. Medicaid and CHIP Payment and Access Commission. Medicaid’s Role in Financing Maternity Care. MACPAC; 2020. Available: https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid%E2%80%99s-Role-in-Financing-Maternity-Care.pdf.

2. The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review.;M Bellerose;Health Affairs.,2022

3. Medicaid Expansion Improved Perinatal Insurance Continuity For Low-Income Women.;JR Daw;Health Affairs.,2020

4. Transitions in Health Insurance During the Perinatal Period Among Patients With Continuous Insurance Coverage;C Jeung;JAMA Netw Open,2022

5. Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level. In: KFF [Internet]. [cited 6 Dec 2023]. Available: https://www.kff.org/health-reform/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level/.

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