Effects Of Medicaid Expansion On Postpartum Coverage And Outpatient Utilization

Abstract

Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Medicaid enrollees are at higher risk of postpartum disruptions in insurance because pregnancy-related Medicaid eligibility ends sixty days after delivery. We used Medicaid claims data for 2013-15 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not. We found that after expansion, new mothers in Utah experienced higher rates of Medicaid coverage loss and accessed fewer Medicaid-financed outpatient visits during the six months postpartum, relative to their counterparts in Colorado. The effects of Medicaid expansion on postpartum Medicaid enrollment and outpatient utilization were largest among women who experienced significant maternal morbidity at delivery. These findings provide evidence that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.

Keywords: Access and use; Access to care; Affordable Care Act; Health policy; Maternal health; Medicaid; Medicaid coverage; Medicaid eligibility; Morbidity; Mortality.

EXHIBIT 3

Mean number of months of postpartum Medicaid coverage in the six months after delivery in Colorado and Utah, January 2013-June 2015 SOURCE Authors’ analysis of data for 2013–15 from all-payer claims databases in Colorado and Utah. NOTES The shaded area highlights deliveries occurring during July-December 2013. These deliveries were treated as transitional in our models because the six-month postpartum periods for deliveries occurring during July-December 2013 extended beyond the date of Colorado’s Medicaid expansion on January 1, 2014. In a test for difference of January-June 2013 trends across states, β = −0.00 and p = 0.637.

Exhibit 4

Mean number of Medicaid-financed outpatient visits in the six months after delivery in Colorado and Utah, January 2013-June 2015 SOURCE Authors’ analysis of data for 2013–15 from all-payer claims databases in Colorado and Utah. NOTES The shaded area highlights deliveries occurring during July–December 2013. These deliveries were treated as transitional in our models because the six-month postpartum periods for deliveries occurring during July–December 2013 extended beyond the date of Colorado’s Medicaid expansion on January 1, 2014. In a test for difference of January–June 2013 trends across states, β = −0.00 and p = 0.243.