Changes to insurance coverage for postpartum women during pandemic

Erica Eliason, PhD

“Studies have shown that the postpartum period is typically a time of heightened insurance instability, primarily because individuals [with] pregnancy-related Medicaid coverage lose eligibility after 60 days postpartum,” said principal investigator Erica Eliason, PhD, postdoctoral research fellow in health services, policy and practice at Brown University School of Public Health in Providence, Rhode Island. “As a result, individuals must qualify for parental Medicaid to maintain Medicaid coverage past this period, which has more restrictive income eligibility, or find alternative insurance options.”

The change in insurance eligibility leads to high uninsurance in the postpartum period for those who had pregnancy-related Medicaid coverage, according to Eliason. “However, to promote insurance access during the COVID-19 public health emergency, there was a Medicaid policy change that froze disenrollment, which meant that anyone who was going to lose Medicaid eligibility no longer did.”

The pandemic Medicaid policy inspired the authors to examine changes in postpartum Medicaid eligibility, “which has been of recent policy interest at the state and national level,” Eliason told Contemporary OB/GYN®.

The investigators culled data from the 2019 to 2021 Current Population Survey, Annual Social and Economic Supplement. (Among the 4,448 postpartum respondents, the shift from insured to uninsured decreased by 1.3%, from 3.1% in 2019 (before the pandemic) to 1.8% during the pandemic in 2021. Results indicated no other significant coverage changes overall.¹

In 2019, 88.2% of postpartum respondents with Medicaid in the prior year had consistent Medicaid coverage, while 10.3% lost coverage and 1.6% changed to private coverage.

In 2021, consistent Medicaid coverage increased by 6.8% and Medicaid-uninsured churn decreased by 6.6%, representing a 64% decline from 2019.

In 2019, 97.1% of all postpartum respondents with private coverage during the prior year also maintained consistent private coverage, while 1.4% had private-Medicaid churn and 1.3% lost coverage.

Compared to 2019, private-Medicaid churn increased by 1.5% in 2021.

“The findings were largely what we expected,” Eliason said. “Although the pandemic policy was not specific to promoting postpartum Medicaid, we anticipated there would be improvements in postpartum Medicaid, because so many were losing Medicaid coverage in this period prior to the policy change.”

Eliason noted that the increase in continuous postpartum coverage should provide enhanced access to care postpartum, “but this policy change occurred during the pandemic, which other research has shown led to reduced health care use, so it might not have achieved the same improvements in postpartum care access that would have occurred if not for the pandemic,” she said.

“Individuals may not have known that they remained insured and as a result may not have seen an improvement in access to postpartum care,” Eliason said.

The pandemic Medicaid policy change continues to be extended, but is currently set to expire in July 2022. “When this policy is lifted, postpartum individuals whose pregnancy-related Medicaid coverage was going to stop after 60 days postpartum will lose this Medicaid coverage,” Eliason said, “and we “could see large numbers of people who had stable Medicaid during the pandemic suddenly uninsured.”

Reference

1. Eliason EL, Daw JR, Steenland MW. Changes in postpartum insurance coverage in the US during the COVID-19 pandemic. JAMA Health Forum. Published online April 22, 2022. doi:10.1001/jamahealthforum.2022.0688