Medicaid coverage expansion reduces postpartum hospitalizations

Expanded Medicaid coverage was associated with a reduction in postpartum hospitalizations in the 6 months — particularly in the first 60 days — after delivery, according to data published in Health Affairs.

“There has been increasing attention to how poorly the United States fares on measures of maternal health when compared to other high-income countries,” Maria W. Steenland, SD, an assistant professor of population studies at Brown University in Providence, Rhode Island, told Healio. “Lawmakers want to identify policies that can be used to improve maternal health. We already knew that Medicaid expansion increased insurance coverage before pregnancy and after childbirth, but little evidence existed about the impact of Medicaid expansion on postpartum health care use and health outcomes. We were motivated to conduct this research to try to add new evidence about the impact of insurance coverage before and after pregnancy on other postpartum outcomes beyond coverage.”

Steenland and Laura R. Wherry, PhD, an assistant professor of economics and public service at New York University, analyzed data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project State Inpatient Databases available from 2010 to 2017. They included four states that expanded Medicaid coverage under the Affordable Care Act — Iowa, Maryland, New Mexico and Washington — and four states that did not — Florida, Georgia, Mississippi and Utah.

To assess changes in hospitalizations, the researchers defined a pre-expansion period from 2010 to 2013 and a post-expansion period from 2014 to 2017. They identified delivery hospitalizations among Medicaid beneficiaries aged 19 years or older and followed each patient through 6 months postpartum.

Primary outcomes were hospitalization within the first 60 days and from 61 days to 6 months after delivery hospitalization discharge.

Prior to Medicaid expansion, the most common reasons for postpartum hospitalization among people whose deliveries were covered by Medicaid were complications of pregnancy, childbirth and the puerperium; digestive system diseases; mental disorders; genitourinary system diseases; and injury and poisoning. Pregnancy or childbirth-related hospitalizations were more common within 60 days vs. within 61 days to 6 months of delivery (70% vs. 8%).

After Medicaid expansion, there was a reduction in hospitalizations within 60 days postpartum in states with expanded Medicaid coverage and an increase in hospitalizations within 60 days postpartum in states that did not have expanded coverage. Postpartum hospitalizations between 61 days and 6 months after delivery did not change significantly after expansion in either group.

Specifically, the rate of hospitalization within 60 days postpartum decreased by 17% in states with expanded Medicaid coverage, 75% of which was due to decreases in childbirth-related hospitalizations.

“Our main finding of a 17% decrease in 60-day postpartum hospitalizations was somewhat surprising since these individuals, prior to the Affordable Care Act expansions, already had access to Medicaid for childbirth that covered them through the first 60 days postpartum,” Steenland said.

Additionally, there was an 8% decrease from baseline within 61 days to 6 months postpartum, although the researchers said it was “imprecisely estimated” due to smaller sample size and low baseline prevalence.

Analyses by race and ethnicity suggested that all groups experienced declines in hospitalizations within 60 days postpartum, according to the researchers.

“Future research to understand why Medicaid expansion reduced postpartum hospitalizations is needed,” Steenland said. “Additionally, states currently have the option to extend Medicaid pregnancy coverage past 60 days through the full first year following delivery as part of the American Rescue Plan Act of 2021. Future research examining the effect of extending pregnancy Medicaid coverage through 1 year postpartum is needed to determine whether this is an effective policy strategy to improve maternal health.”