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Postpartum Insurance Rates Among Citizens Versus Noncitizens During the COVID-19 Public Health Emergency.

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Medicaid continuous coverage provision (CCP) did not significantly reduce postpartum insurance gaps for low-income noncitizen immigrants compared to citizens. Coverage inequities persisted, leaving many noncitizens uninsured despite CCP policies.

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Health Equity

Background:

  • The COVID-19 public health emergency prompted Medicaid continuous coverage provision (CCP) to maintain insurance for low-income individuals.
  • Disparities in postpartum insurance coverage exist between low-income citizens and noncitizen immigrants.
  • State policies, such as from-conception-to-the-end-of-pregnancy (FCEP), may affect immigrant postpartum coverage.

Purpose of the Study:

  • To evaluate the impact of CCP on postpartum insurance for low-income noncitizen immigrants versus citizens.
  • To determine if state FCEP policies modified the effect of CCP on noncitizen postpartum coverage.
  • To assess postpartum coverage inequities between noncitizen immigrants and citizens under CCP.

Main Methods:

  • Employed a quasi-experimental difference-in-differences (DID) design comparing insurance gains.
  • Utilized a triple difference (DDD) approach to analyze the effect of FCEP-only policies.
  • Analyzed 2016-2022 American Community Survey data for low-income citizens and noncitizens across 8 FCEP-only states and 23 other states.

Main Results:

  • In 2021, Medicaid gains for noncitizens were statistically similar to citizens in both FCEP-only and various pathway states compared to 2019.
  • These similar gains did not persist into 2022, indicating a temporary effect.
  • No significant differences in insurance coverage gains were observed among noncitizens between FCEP-only states and states with various pathways.

Conclusions:

  • CCP did not substantially reduce postpartum coverage inequities for low-income noncitizen immigrants.
  • Significant postpartum coverage disparities persisted for noncitizens, leaving many uninsured.
  • State FCEP policies did not appear to mitigate these persistent coverage gaps under CCP.