Association of COVID‐19 Continuous Enrollment With Self‐Reported Postpartum Medicaid Continuity and Coverage Inequities
ABSTRACT Objective To examine the impact of extended postpartum Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) on self‐reported postpartum insurance status among prenatal Medicaid recipients, and differences by state Medicaid expansion status and race, and ethnicity....
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| Published in | Health services research Vol. 60; no. 4; pp. e14618 - n/a |
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| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.08.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0017-9124 1475-6773 1475-6773 |
| DOI | 10.1111/1475-6773.14618 |
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| Summary: | ABSTRACT
Objective
To examine the impact of extended postpartum Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) on self‐reported postpartum insurance status among prenatal Medicaid recipients, and differences by state Medicaid expansion status and race, and ethnicity.
Study Setting and Design
We used a global polynomial linear regression discontinuity design (RDD) approach to estimate the effect of extended postpartum Medicaid eligibility during the FFCRA on changes in self‐reported postpartum Medicaid, private coverage, and uninsurance. This approach compares individuals who gave birth before FFCRA exposure with those who gave birth during extended postpartum Medicaid eligibility, using birth timing to determine FFCRA exposure. We estimated RDD models overall, by state Medicaid expansion status, and by race and ethnicity.
Data Sources and Analytic Sample
This study used 2018–2021 Pregnancy Risk Assessment Monitoring System data, a multi‐state survey of individuals with a recent live birth, and a sample of prenatal Medicaid recipients age 20 or older in 29 study jurisdictions.
Principal Findings
In adjusted RDD models, extended Medicaid eligibility was associated with a 10.7 percentage point (pp) (95% CI: 8.7, 12.6) increase in postpartum Medicaid, a 3.5 pp (95% CI: −5.2, −1.8) decrease in postpartum private coverage, and a 6.5 pp (95% CI: −8.0, −5.0) decrease in postpartum uninsurance. In stratified RDD models, we found larger increases in postpartum Medicaid and larger decreases in uninsurance in non‐expansion states than in Medicaid expansion states. In RDD models by race and ethnicity, we found similar increases in postpartum Medicaid and similar decreases in postpartum uninsurance among non‐Hispanic Black respondents, Hispanic respondents, and non‐Hispanic White respondents.
Conclusions
We found significant improvements in postpartum Medicaid continuity and reductions in uninsurance during extended postpartum Medicaid eligibility. Postpartum Medicaid extensions under the American Rescue Plan could help maintain some coverage gains under the FFCRA. |
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| Bibliography: | Dr. Erica L. Eliason received support for this research from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [K99 HD111622]. This research represents the findings and opinions of the authors and does not necessarily reflect the views of the National Institutes of Health or the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Sarah H. Gordon reports funding unrelated to this work from the National Institute of Mental Health, NICHD, the National Institute for Dental and Craniofacial Research, the National Institute of Minority Health and Health Disparities, the Commonwealth Fund, and the Robert Wood Johnson Foundation. Dr. Sarah H. Gordon serves as a senior advisor on health policy in the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services. The findings and opinions in this manuscript do not reflect the official views of the US Department of Health and Human Services. Dr. Maria W. Steenland was supported by the P2CHD041020 from the National Institute of Child Health and Human Development (NICHD) and a K01HS027464 from the Agency for Healthcare Research and Quality. She also received funding unrelated to this work from NICHD, the National Institute for General Medical Sciences and the National Institute of Dental and Craniofacial Research. Funding ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Funding: Dr. Erica L. Eliason received support for this research from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [K99 HD111622]. This research represents the findings and opinions of the authors and does not necessarily reflect the views of the National Institutes of Health or the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Sarah H. Gordon reports funding unrelated to this work from the National Institute of Mental Health, NICHD, the National Institute for Dental and Craniofacial Research, the National Institute of Minority Health and Health Disparities, the Commonwealth Fund, and the Robert Wood Johnson Foundation. Dr. Sarah H. Gordon serves as a senior advisor on health policy in the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services. The findings and opinions in this manuscript do not reflect the official views of the US Department of Health and Human Services. Dr. Maria W. Steenland was supported by the P2CHD041020 from the National Institute of Child Health and Human Development (NICHD) and a K01HS027464 from the Agency for Healthcare Research and Quality. She also received funding unrelated to this work from NICHD, the National Institute for General Medical Sciences and the National Institute of Dental and Craniofacial Research. |
| ISSN: | 0017-9124 1475-6773 1475-6773 |
| DOI: | 10.1111/1475-6773.14618 |