Longer Postpartum Medicaid Coverage Prevents Maternal Uninsurance

May 28, 2020 - Extending postpartum Medicaid insurance could make postpartum healthcare more affordable for new mothers and improve health outcomes , a recent report from the Urban Institute found.

“Uninsured new mothers report trouble affording care and have both physical and mental health needs that would benefit from the more consistent access to coverage and care that expanding Medicaid would provide,” the report stated. “These findings are particularly relevant given the COVID-19 pandemic and ensuing economic crisis, which will put even more women at risk of uninsurance and in need of affordable coverage options before, during, and after pregnancy.”

Experts from the Urban Institute analyzed data from the National Health Interview Survey from 2015 through 2018 and the Pregnancy Risk Assessment and Monitoring System of 2015 through 2017. The data provided a fuller picture of unmet medical needs, the rate of delayed maternal care, financial barriers, how long the mothers had been without coverage, the causes for loss or lack of insurance, and other factors.

The data indicated that new mothers required more extensive postpartum care than simply a postpartum checkup. Losing Medicaid after giving birth was the main cause for uninsurance. Uninsured mothers expressed concern regarding their ability to pay medical bills and would skip care in order to avoid costs.

Expanding Medicaid, on the other hand, has seen positive results in improving postpartum care utilization and coverage stability.

With these factors in mind, the researchers concluded that extending Medicaid beyond the immediate postpartum period could be critical to improving maternal healthcare.

The researchers found that 11.5 percent of new mothers nationwide were uninsured. Over the four years that this survey data spans, the majority of the respondents had just gained insurance. Over 44 percent had insurance in the six months prior to taking the survey. But 21.1 percent had never had insurance.

Most of the uninsured mothers surveyed (83.8 percent) reported having a postpartum checkup. However, the results also indicated that many also had conditions that require more long-term care, for example postpartum depression or after care for a cesarean-section delivery.

There were a variety of reasons for losing healthcare coverage. Nearly half of these mothers (47.4 percent) lost eligibility for Medicaid or their health insurance plan following their pregnancy.

Without health insurance, mothers face a host of challenges that can lead to adverse maternal health outcomes. Primary among those challenges is the cost of healthcare.

Most of the respondents (83.5 percent) said that they were somewhat or very concerned about paying for their medical bills. Over 14 percent admitted to having an unmet medical need that they could not address due to affordability and 16.2 percent said that they delayed care because they could not afford higher healthcare spending. For 17 percent of the mothers, high prescription drug costs prevented them from maintaining medication adherence.

In some ways, the coronavirus pandemic may have improved healthcare coverage conditions for new and otherwise uninsured mothers, the Urban Institute researchers suggested.

The Families First Coronavirus Response Act, which eliminated much of the cost for coronavirus testing for members and beneficiaries, required Medicaid programs to maintain coverage for their beneficiaries during the coronavirus pandemic. This provided more consistent healthcare coverage for mothers during the crisis and gave states the opportunity to test out extended postpartum coverage.

At the same time, the coronavirus pandemic introduced other challenges for this population. Mothers may have deferred care more frequently because they did not want to be exposed to the coronavirus. Isolation and lack of support may have exacerbated mental health conditions in a population already vulnerable to poor mental health.

Ultimately, the experts recommended that states move toward solutions with greater longevity than simply expanding postpartum coverage.

“Longer-term solutions to addressing the maternal morbidity and mortality crisis would involve achieving continuous coverage and care throughout a woman’s reproductive years,” the researchers stated. “A more comprehensive Medicaid expansion, for example, would allow more low-income women to identify and manage their chronic conditions, plan and support wanted pregnancies, and maintain good health to support ongoing maternal and child well-being.”

In addition to extending longer term care, some private payers have also found that value-based care solutions assist in conquering maternal care disparities and negative outcomes. Priority Health, for example, used payment incentives to encourage providers to place at-risk mothers in a peer support program.