Addressing Maternal and Child Health Disparities Through Perinatal Home Visiting

Consistent access to health care before, during, and after pregnancy is critical in the United States, where high rates of maternal morbidity and pregnancy-related mortality persist. Medicaid plays a critical role in financing health care coverage for pregnancy and childbirth in the US, including postpartum care.

We used Wisconsin birth certificate records linked to Medicaid enrollment files for 2009 through 2018 to determine maternal Medicaid coverage spanning the 12 months pre-pregnancy to 12 months postpartum. Covariates included age, race/ethnicity, parity, education, and marital status. Analysis included descriptive statistics and log-binomial regression to predict adjusted risk of postpartum Medicaid coverage loss.

Of 267,416 Medicaid-covered births in our sample, 50.5% (n= 1 34,970) were continuously enrolled while 33.1%, (n = 88,425) were never enrolled during the 12 months pre-pregnancy. Most (97.9%, n = 261,713) were enrolled at some time during the prenatal period, and a majority of mothers (86.1%, n = 230,325) were enrolled consistently throughout the first postpartum year. Postpartum unenrollment peaked in month 3, when 34.2% of unenrollment occurred. Those younger, married, and with lower parity had higher risk of unenrollment. Notably, those reporting non-Hispanic Black were at the lowest risk, while non-Hispanic Asian/Pacific Islanders were at a higher risk of unenrollment.

The extension of postpartum coverage to 90 days may address one-third of the postpartum Medicaid loss observed, postponing coverage loss an additional month. A full 12-month postpartum Medicaid extension would support postpartum health by ensuring health care access during this critical period.