Race, Medicaid Coverage, and Equity in Maternal Morbidity

Area of Science:

• Public Health
• Health Equity
• Maternal Health

Background:

• Severe maternal morbidity (SMM) impacts 50,000 US deliveries annually.
• Medicaid-covered deliveries have 1.5x higher SMM rates than privately covered ones.
• Non-Hispanic Black and Hispanic women face significantly higher SMM rates compared to White women.

Purpose of the Study:

• To compare severe maternal morbidity (SMM) rates across different races/ethnicities and insurance types.
• To investigate the intersectionality of race/ethnicity and insurance status in SMM.
• To understand how systemic oppression and racism contribute to SMM inequities.

Main Methods:

• Utilized 2016-2017 Healthcare Cost and Utilization Project National Inpatient Sample data.
• Conducted multivariate logistic regression analyses.
• Evaluated maternal outcomes equity by primary payer, overall and stratified by race/ethnicity.

Main Results:

• Overall SMM rate was 138.3 per 10,000 deliveries.
• SMM disparities between racial/ethnic groups were smaller among Medicaid-covered deliveries.
• Black women with Medicaid did not show significantly higher SMM risk compared to Black women with private insurance in stratified analysis.

Conclusions:

• Black women with Medicaid do not have disproportionately higher SMM rates than those with private insurance.
• Focus policy efforts on structural racism and socioeconomic factors impacting maternal health.
• Address barriers to high-quality care for women with Medicaid coverage.