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Medicaid Expansion and Rural-Urban Disparities in Postpartum Medicaid Coverage.
Elizabeth Boggs1, Andrei Stefanescu2,3, Mark Gritz1,4
1Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
Public Health Reports (Washington, D.C. : 1974)
|February 4, 2026
Summary
Medicaid expansion under the Affordable Care Act significantly increased postpartum health insurance coverage for rural women, narrowing the gap between rural and urban residents. This policy change helped reduce geographic disparities in postpartum insurance access.
Area of Science:
- Health Services Research
- Public Health Policy
- Rural Health Disparities
Background:
- Rural residents face higher rates of postpartum uninsurance, exacerbating maternal health outcome disparities.
- Geographic disparities in postpartum health insurance coverage persist between rural and urban populations.
Purpose of the Study:
- To examine the impact of Medicaid expansion on rural-urban disparities in postpartum health insurance coverage among low-income women.
- To assess how the Affordable Care Act's Medicaid expansion influenced postpartum insurance rates in rural versus urban areas.
Main Methods:
- Utilized nationally representative American Community Survey data from 2010-2012 and 2015-2019.
- Employed difference-in-differences and difference-in-difference-in-differences analyses to compare postpartum insurance coverage rates.
- Compared outcomes in states that expanded Medicaid versus those that did not.
Main Results:
- Rural women experienced the largest increases in postpartum health insurance coverage, particularly in Medicaid-expanding states (17.0 pp increase).
- Medicaid expansion narrowed the rural-urban disparity in postpartum insurance coverage by 4.8 percentage points.
- Similar positive trends were observed for Medicaid-specific postpartum coverage.
Conclusions:
- Medicaid expansion reduced geographic disparities in postpartum health insurance coverage, benefiting rural women disproportionately.
- Further research is needed to determine if these coverage gains translate to improved postpartum care access for rural communities.
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