Rural-Urban Differences in Coverage Gains Under Continuous Postpartum Medicaid Eligibility

Area of Science:

• Health Services Research
• Public Health Policy
• Rural Health Disparities

Background:

• Rural populations experience higher obstetric complication rates.
• Postpartum insurance loss disproportionately affects rural residents, limiting care access.
• The COVID-19 public health emergency (PHE) provided continuous Medicaid eligibility, impacting postpartum coverage.

Purpose of the Study:

• To examine the impact of continuous Medicaid eligibility during the PHE on postpartum insurance coverage.
• To compare coverage changes in rural versus urban populations.
• To assess the influence of state-level pregnancy-related Medicaid eligibility variations.

Main Methods:

• Utilized 2017-2022 American Community Survey data.
• Evaluated state-level variations in pregnancy-related Medicaid eligibility during the PHE.
• Analyzed postpartum insurance coverage among rural and urban residents.

Main Results:

• Medicaid coverage increased significantly for both rural and urban populations.
• Rural mothers saw a 6.4 percentage-point greater gain in Medicaid coverage with increased eligibility thresholds.
• Overall postpartum insurance gains were not significantly larger for rural mothers.

Conclusions:

• Postpartum Medicaid extensions may increase coverage more in rural communities.
• Policymakers should consider these findings to address rural postpartum care access.
• Mitigating Medicaid budget constraints' impact on rural populations is crucial.