Abstract
Objectives
This study investigated the predictors of postpartum insurance loss (PPIL), assessed its association with postpartum healthcare receipt, and explored the potential buffering role of Medicaid expansion.
Methods
Data from the 2016–2020 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed, covering 197,820 individuals with live births. PPIL was determined via self-reported insurance status before and after pregnancy. Postpartum visits and depression screening served as key health service receipt indicators. The association between PPIL and maternal characteristics was examined using bivariate analysis. The association of PPIL with health service receipt was assessed through odds ratios derived from multivariate logistic regression models. The role of Medicaid expansion was explored by interacting ACA Medicaid expansion status with the dichotomous PPIL indicator.
Results
PPIL was experienced by 7.8% of postpartum people, with higher rates in Medicaid non-expansion states (13.6%) compared to 6.1% in expansion states (p < 0.05). Racial and ethnic disparities were observed, with 16.5% of Hispanic and 4.6% of white people experiencing PPIL. Individuals who experienced PPIL had decreased odds of attending postpartum visits (adjusted odds ratio (aOR) = 0.81, 95% CI = 0.73–0.90) and receiving screening for postpartum depression (aOR = 0.86, 95% CI = 0.78–0.96) compared to those who maintained insurance coverage. People in expansion states with no PPIL had higher odds of postpartum depression screening (aOR = 1.33, 95% CI = 1.08–1.62). No differences in postpartum visits in expansion versus non-expansion were noted (aOR = 1.13, 95% CI = 0.93–1.36).
Conclusions for Practice
Ensuring consistent postpartum insurance coverage offers policymakers a chance to enhance healthcare access and outcomes, particularly for vulnerable groups.
Significance
As numerous US states extend postpartum Medicaid coverage under the American Rescue Plan, understanding postpartum insurance loss (PPIL) and its association with healthcare for new mothers becomes vital. We identify PPIL risk factors and gauge its effect on accessing essential health services postpartum, focusing on Medicaid expansion’s role. Our insights inform policies to enhance postpartum healthcare utilization and insurance access.
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The first author maintains exclusive access to these data on a HIPAA secure server, per IRB protocol with an executed limited data use agreement with PRAMS.
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Acknowledgements
The authors gratefully acknowledge the Centers for Disease Prevention and Control (CDC) for providing access to The Pregnancy Risk Assessment Monitoring System (PRAMS) data for this study.
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This study has not received financial support from any funder.
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W.S.M. secured data, completed conception/design, literature review, analysis, and drafting of the article. MW contributed to article writing and interpretation of results. J.L contributed to the data analysis, manuscript writing and interpretation of results. N.H. offered input on the conceptualization of the study and analysis approach and contributed to the analysis and writing of the article. All have reviewed and edited the article drafts.
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The East Tennessee State University IRB deemed this non-human subjects research.
Informed Consent
The East Tennessee State University IRB deemed this non-human subjects research. Data are de-identified. The Centers for Disease Prevention and Control (CDC) provided approval for the use of the de-identified pregnancy Risk Assessment Monitoring System (PRAMS) data for this research under a limited data use agreement.
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Manalew, W.S., White, M., Lee, J. et al. Postpartum Insurance Loss: Predicting Factors, Associations with Postpartum Health Service Utilization, and the Role of Medicaid Expansion. Matern Child Health J 28, 1782–1792 (2024). https://doi.org/10.1007/s10995-024-03979-3
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DOI: https://doi.org/10.1007/s10995-024-03979-3