Extended Pregnancy Medicaid During COVID-19 and Enrollment and Health Care Use in the Postpartum Year

Policy Points The continuous coverage provision of the March 2020 Families First Coronavirus Response Act resulted in extended postpartum Medicaid for individuals with pregnancy Medicaid coverage, which increased postpartum Medicaid enrollment, improved continuity of coverage, and increased Medicaid-paid emergency department visits and mental and behavioral health diagnoses in the 3 to 12 months postpartum. These findings provide insight into the extent to which increased coverage translated into changes in postpartum Medicaid-paid care. Communication and outreach are likely needed to ensure that individuals are aware of and able to use their extended postpartum Medicaid coverage.

Before the COVID-19 pandemic, persons with pregnancy Medicaid coverage were typically disenrolled after 60 days postpartum, at which point they could retain Medicaid only if they qualified through another eligibility category (most commonly as a parent). The March 2020 Families First Coronavirus Response Act (FFCRA) extended postpartum Medicaid coverage by requiring states to pause disenrollment in exchange for enhanced federal funding.

This study examined 2019-2022 Medicaid claims data from 15 states to determine the association between extended postpartum Medicaid coverage and Medicaid-paid care. We employed a continuous difference-in-difference design, leveraging variations in FFCRA-associated eligibility changes (state-level differences in pre-FFCRA pregnancy and parental Medicaid eligibility as a percentage of the federal poverty level [FPL]). The study population included individuals with a birth between January 2019 and December 2021 that was paid for by pregnancy Medicaid coverage. The study population was followed for 12 months after childbirth. Outcomes included Medicaid enrollment, continuity of coverage, outpatient and emergency department visits, and pregnancy-related and mental-health-related diagnoses. Care outcomes were measured from 3 to 12 months postpartum.

In adjusted models, we found that a 100 percentage-point FPL increase in postpartum Medicaid eligibility under the FFCRA was associated with 2.9 additional months of enrollment (95% CI: 0.9, 4.3), a 27.3 percentage-point increase in 12-month continuous Medicaid (95% CI: 2.3, 44.6), 107.2 more emergency department visits per 1,000 beneficiaries (95% CI: 18.7, 167.6), and a 3.2 percentage-point (95% CI: 1.7, 5.4) increase in services with mental and behavioral health diagnoses.

Continuous Medicaid coverage during the FFCRA was associated with longer postpartum enrollment and increases in some health care utilization. However, no increases in Medicaid-paid outpatient care or care for pregnancy-related conditions were found, which may have been due to enrollees' limited awareness of their continued eligibility. Improved communication around extended postpartum Medicaid coverage may improve the translation of coverage into health care access.