Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York.
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
JAMA Health Forum. 2021 Jun 14;2(6):e211054. doi: 10.1001/jamahealthforum.2021.1054. eCollection 2021 Jun.
To reduce postpartum uninsurance and improve postpartum health, the American Rescue Plan included an option for states to extend pregnancy-related Medicaid from 60 days to 1 year after childbirth. Recent estimates of postpartum uninsurance among Medicaid-paid births would provide information on who would benefit from state adoption of this extension.
To estimate rates of postpartum uninsurance among individuals with Medicaid-paid births.
This cross-sectional study used survey data from the 2015 to 2018 Pregnancy Risk Assessment Monitoring System (PRAMS), a representative sample of births in 43 states and New York City, New York, and included PRAMS participants for whom Medicaid was the primary payer for childbirth. The mean weighted PRAMS response rate was 60.9% for the sites and years included in this study. The data were analyzed from December 2020 to January 2021.
Self-reported postpartum uninsurance measured at the time of the PRAMS survey (mean [interquartile range], 4.2 (3.0-5.0) months after birth).
Survey-weighted rates of postpartum uninsurance and 95% CIs overall, by state, by state Medicaid expansion status, and by maternal sociodemographic characteristics. Adjusted odds ratios of the association between maternal characteristics and postpartum uninsurance.
We identified 63 370 respondents with a Medicaid-paid birth. Of these, 22 016 (41.1%) were non-Hispanic White individuals, 17 442 (22.0%) non-Hispanic Black individuals, 6808 (13.3%) Spanish-speaking Hispanic individuals, 7000 (13.7%) English-speaking Hispanic individuals, 2410 (4.0%) Asian/Pacific Islander individuals, and 3894 (1.3%) Indigenous individuals. Of these, 41.7% were no longer insured by Medicaid postpartum and 22.0% were uninsured postpartum. The postpartum uninsurance rate was 3 times higher in Medicaid nonexpansion states (36.8%) compared with expansion states (12.8%). Postpartum uninsurance varied significantly across states, ranging from 1.7% in Massachusetts to 56.7% in Texas. There were substantial racial and ethnic disparities in postpartum uninsurance: 54.9% of Hispanic, Spanish-speaking individuals (adjusted odds ratio [aOR], 6.2; 95% CI, 5.5-7.0) and 42.8% of Indigenous respondents reported postpartum uninsurance (aOR, 4.3; 95% CI, 3.8-4.9) compared with 15.2% of non-Hispanic White respondents. The odds of postpartum uninsurance was higher among unmarried people (aOR, 1.3 compared with married people; 95% CI, 1.2-1.4), those 35 years and older (aOR, 1.5 compared with those younger than 20 years; 95% CI, 1.2-1.9) and those with lower levels of education (aOR, 0.8 for more than high school compared with less than high school; 95% CI, 0.7-0.9).
In this cross-sectional survey study of 43 states, a high proportion of people with Medicaid-paid births were uninsured in the postpartum period, particularly those living in Medicaid nonexpansion states. The study findings suggest that state extensions of pregnancy-related Medicaid eligibility through the first year postpartum could disproportionately benefit Hispanic and Indigenous people, unmarried people, those with lower education levels, and those living in Medicaid nonexpansion states.
为了减少产后脱保现象并改善产后健康状况，《美国救援计划》为各州提供了一项选择，允许将与妊娠相关的医疗补助从产后 60 天延长至 1 年。最近对医疗补助支付分娩后脱保率的估计将为谁将受益于该扩展提供信息。
估计 Medicaid 支付分娩后脱保率。
设计、设置和参与者：本横断面研究使用了 2015 年至 2018 年妊娠风险评估监测系统（PRAMS）的调查数据，这是 43 个州和纽约市的代表性分娩样本，包括 Medicaid 是分娩主要支付者的 PRAMS 参与者。包括的站点和年份的加权 PRAMS 回复率为 60.9%。数据分析于 2020 年 12 月至 2021 年 1 月进行。
在 PRAMS 调查时报告的产后脱保情况（平均值[四分位距]，产后 4.2（3.0-5.0）个月）。
总体、按州、按州 Medicaid 扩展状态和按产妇社会人口统计学特征加权的产后脱保率和 95%置信区间。产妇特征与产后脱保之间关联的调整比值比。
我们确定了 63370 名 Medicaid 支付分娩的受访者。其中，22016 人（41.1%）是非西班牙裔白人，17442 人（22.0%）是非西班牙裔黑人，6808 人（13.3%）是讲西班牙语的西班牙裔人，7000 人（13.7%）是讲英语的西班牙裔人，2410 人（4.0%）是亚洲/太平洋岛民，3894 人（1.3%）是美洲原住民。其中，41.7%的人在产后不再由 Medicaid 承保，22.0%的人在产后没有保险。与扩展州（12.8%）相比， Medicaid 非扩展州（36.8%）的产后脱保率高 3 倍。各州的产后脱保率差异显著，从马萨诸塞州的 1.7%到德克萨斯州的 56.7%不等。产后脱保率存在显著的种族和民族差异：与非西班牙裔白人受访者的 15.2%相比，讲西班牙语的西班牙裔受访者（调整比值比[aOR]，6.2；95%置信区间[CI]，5.5-7.0）和 42.8%的美洲原住民受访者报告了产后脱保（aOR，4.3；95%CI，3.8-4.9）。与已婚人士相比，未婚人士（aOR，1.3 与已婚人士相比；95%CI，1.2-1.4）、35 岁及以上人士（aOR，1.5 与 20 岁以下人士相比；95%CI，1.2-1.9）和受教育程度较低的人士（aOR，与高中以下相比，aOR 为 0.8；95%CI，0.7-0.9）的产后脱保风险更高。
在这项针对 43 个州的横断面调查研究中，相当一部分 Medicaid 支付分娩的人在产后期间没有保险，特别是那些生活在 Medicaid 非扩展州的人。研究结果表明，通过将妊娠相关的 Medicaid 资格延长至产后第一年，可能会使西班牙裔和美洲原住民、未婚人士、受教育程度较低的人士和生活在 Medicaid 非扩展州的人士受益。
