Preparing for the Postpartum Medicaid Extension Evaluation in Illinois

Abstract

AbstractBackgroundGiven increased attention to the maternal health crisis, its heavy toll on Black birthing persons, and recognition that most pregnancy-related deaths occur in the extended postpartum period, Illinois implemented a Postpartum Medicaid Extension (PME).ObjectivesThe purpose of this study was to use baseline data from the pre-PME period to ascertain which groups of eligible persons can be expected to experience improved outcomes as a result of PME implementation in Illinois.MethodsWe focused on the Well-Woman Visit (WWV) as it can be measured in the later postpartum period and is relevant for non-pregnant women. We provide baseline prevalence estimates for WWV receipt using PRAMS and BRFSS data within income strata and within combined income-insurance strata with particular attention to the income group most likely to be affected by the PME. Using multivariable binomial regression, we generate adjusted prevalence differences across income and insurance strata overall and by race/ethnicity.ResultsThe Illinois PME has the potential to improve the receipt of well-woman care in the 138-213% FPL income group, the group most likely to be affected by the PME. The analysis also suggests that Black women in Illinois may not be the group most likely to benefit from the enhanced access to care made available by the PME without additional focused attention to their particular needs and experiences. Conclusions and Implications for Practice and Policy:The PME is necessary but not sufficient for addressing racial/ethnic inequities in maternal health. Leveraging the opportunity that the PME provides to design and support delivery models that maximize the effects of such coverage will be essential to address the maternal health crisis in Illinois. Without extra attention to the needs and experiences of Black women, focused on the delivery of care as well as the structural determinants of health including institutional and interpersonal racism, the benefits of the PME for Black women may not be fully realized.Recommendations for PracticeAn extensive outreach and communications campaign focused on the Postpartum Medicaid Extension in Illinois is necessary so that all birthing persons covered by Medicaid and their providers know that postpartum coverage now continues through 12 months.New approaches to care are needed to maximize the benefits of the PME, including elevation of the medical care home for women’s primary/interconception care, efforts to reduce provider bias in the delivery of care, and implementation of postpartum care models such as the Two-Generation approach.Development of a Performance Measurement System within Medicaid focused on the extended postpartum period is essential to ensure that Medicaid providers are aware of the PME and pay particular attention to the extended postpartum period.Promotion of enhanced postpartum care packages that include reimbursement for services to address the structural/social determinants of health is essential.