Background: Postpartum care is important for promoting maternal and infant health and well-being. Nationally, less than 60% of Medicaid-enrolled women attend their postpartum visit. The Strong Start for Mothers and Newborns II Initiative, an enhanced prenatal care program, intended to improve birth outcomes among Medicaid beneficiaries, enrolled 45,599 women, and included a variety of approaches to increasing engagement in postpartum care. Methods: This study analyzes qualitative case studies that include coded notes from 739 interviews with 1,074 key informants and 133 focus groups with 951 women; 4 years of annual memos capturing activities by each of 27 awardees and 24 Birth Center sites; and a review of interview and survey data from Medicaid officials in 20 states. Results: Strong Start prenatal care included education and support regarding postpartum care and concerns. Key informants identified Strong Start services and other strategies they perceived as increasing access to postpartum care, including provider and/or care coordinator continuity across prenatal, delivery, and postpartum visits; efforts to address information gaps and link women to appropriate resources; enhancing services to meet needs such as treatment for depression; addressing barriers related to transportation and childcare; and aligning incentives to encourage prioritization of postpartum care among patients and providers. They also identified ongoing barriers to postpartum visit attendance. Conclusions: Postpartum care is essential to maternal and infant health. Medicaid enrolls many high-risk women and is the largest payer for postpartum care. Using lessons from Strong Start, providers who serve Medicaid-enrolled women can advance strategies to improve postpartum visit access and attendance.
Keywords: Medicaid; perinatal care; postpartum care; prenatal care; reproductive health.