Postpartum readmission and uninsurance at readmission for Medicaid vs privately insured births

Routine postpartum care is essential for managing pregnancy complications, like hypertension and diabetes, or screening for new conditions, such as depression. Insurance coverage can impact women's ability to access these postpartum services, with women who change or lose insurance postpartum having a lower likelihood of receiving the recommended postpartum care. Pregnancy-related Medicaid eligibility is only federally guaranteed for a minimum of 60 days after birth, creating the potential for publicly insured women to lose their insurance and their access to postpartum care.

The objective of this study was to examine the rates of postpartum readmission and predictors of uninsurance at readmission before and after 60 days postpartum for Medicaid vs privately paid births.

This was a retrospective cohort study in which data from the 2017 Nationwide Readmissions Database were used. Women who delivered with Medicaid or private insurance between January 2017 and June 2017 were included. Potential readmissions that were identified between 0 and 180 days after their childbirth hospitalization were included. The primary outcomes of interest were postpartum readmission and delivery payer at postpartum readmission, evaluated at 30-day intervals up to 180 days postpartum. Multivariable logistic regressions were used to determine the association of the risk for readmission and the risk for being uninsured at the time of readmission with insurance provider at the time of delivery. The analysis was also conducted for a subset of acute-cause readmissions or those not likely to be related to chronic or preexisting medical conditions.

A total of 24,719 (2.7%) patients were readmitted within 180 days after delivery: 14,179 (54.1%) had Medicaid delivery insurance and 10,540 (40.2%) had private insurance at delivery. Readmission rates decreased over the time intervals after delivery for both delivery payer types, but were consistently higher for those with Medicaid. The rate of uninsurance at readmission increased more with each postpartum month for those with Medicaid than for those with private insurance at delivery: from 0.9% (95% confidence interval, 0.7-1.1) at 0 to 30 days to 9.7% (95% confidence interval, 8.1-11.6) at 150 to 180 days postpartum for those with Medicaid and from 0.2% (95% confidence interval, 0.1-0.4) at 0 to 30 days to 2.6% (95% confidence interval, 1.6-4.1) at 150 to 180 days postpartum for those with private insurance. Medicaid coverage at the time of delivery was a significant predictor of being readmitted (adjusted odds ratio, 1.86; 95% confidence interval, 1.75-1.97) and uninsured at the time of readmission (adjusted odds ratio, 3.99; 95% confidence interval, 2.88-5.52) when compared with being privately insured. Findings were similar for the acute-cause readmissions.

Women with Medicaid at delivery have a higher risk for readmission and uninsurance at readmission than privately insured women beyond 60 days postpartum. This analysis provides further evidence of the insurance instability women face in the postpartum period, especially by those insured by Medicaid at the time of delivery, and should promote discussions among policymakers, payers, and providers on strategies to ensure coverage and access to care for women and their families after childbirth. For states considering to expand their eligibility criteria to 1 year postpartum, this study provides evidence on the vulnerabilities and unique risks that women with Medicaid face after 60 days postpartum.