Severe Postpartum Maternal Morbidity: How Medicaid Coverage for 365 Days Can Make a Difference

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• Severe maternal morbidity (SMM) is a significant public health concern.
• The American Rescue Plan Act of 2021 extended Medicaid postpartum coverage to 12 months to ensure care continuity.
• Understanding SMM patterns is crucial for effective healthcare management.

Purpose of the Study:

• To describe the incidence and timing of severe maternal morbidity (SMM) in a large national insurer dataset.
• To identify risk factors associated with SMM.
• To inform the impact of extended postpartum Medicaid coverage.

Main Methods:

• A 10-year medical claims and eligibility dataset from a major US national insurer was analyzed.
• Inclusion criteria focused on deliveries with continuous eligibility for 365 days postpartum, excluding subsequent pregnancies or death.
• Statistical analyses included Wilcoxon rank sum and chi-squared tests.

Main Results:

• 3.2% of 105,654 postpartum episodes involved SMM (3,396 cases).
• Common SMM conditions included sepsis (29.4%), acute respiratory distress syndrome (17.5%), and heart failure (15.7%).
• SMM occurred both early (50% before 9 days) and late (25% after 131 days) postpartum. Older age, preterm birth, cesarean delivery, and depression were associated with higher SMM risk.

Conclusions:

• Identifying SMM presence and timing is vital for case management interventions.
• Extended Medicaid coverage offers opportunities to monitor healthcare access and manage high-risk pregnancies.
• Findings underscore the importance of comprehensive postpartum care and support systems.