Marina C. Jenkins, PhD; Christine Piette Durrance, PhD; Deborah B. Ehrenthal, MD, MPH
WMJ. 2024;123(6):434-440.
ABSTRACT
Introduction: Consistent access to health care before, during, and after pregnancy is critical in the United States, where high rates of maternal morbidity and pregnancy-related mortality persist. Medicaid plays a critical role in financing health care coverage for pregnancy and childbirth in the US, including postpartum care.
Methods: We used Wisconsin birth certificate records linked to Medicaid enrollment files for 2009 through 2018 to determine maternal Medicaid coverage spanning the 12 months pre-pregnancy to 12 months postpartum. Covariates included age, race/ethnicity, parity, education, and marital status. Analysis included descriptive statistics and log-binomial regression to predict adjusted risk of postpartum Medicaid coverage loss.
Results: Of 267,416 Medicaid-covered births in our sample, 50.5% (n= 1 34,970) were continuously enrolled while 33.1%, (n = 88,425) were never enrolled during the 12 months pre-pregnancy. Most (97.9%, n = 261,713) were enrolled at some time during the prenatal period, and a majority of mothers (86.1%, n = 230,325) were enrolled consistently throughout the first postpartum year. Postpartum unenrollment peaked in month 3, when 34.2% of unenrollment occurred. Those younger, married, and with lower parity had higher risk of unenrollment. Notably, those reporting non-Hispanic Black were at the lowest risk, while non-Hispanic Asian/Pacific Islanders were at a higher risk of unenrollment.
Conclusions: The extension of postpartum coverage to 90 days may address one-third of the postpartum Medicaid loss observed, postponing coverage loss an additional month. A full 12-month postpartum Medicaid extension would support postpartum health by ensuring health care access during this critical period.