Department of Obstetrics and Gynecology, Division of Women's Community and Population Health, Duke University School of Medicine, Durham, NC, United States of America.
Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States of America.
PLoS One. 2024 Apr 3;19(4):e0299818. doi: 10.1371/journal.pone.0299818. eCollection 2024.
Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the preconception and postpartum periods. Pregnancy Medicaid has higher income limits for eligibility than traditional Medicaid but only provides coverage during and for a limited time period after pregnancy. Our objective was to determine the association between type of Medicaid (traditional Medicaid and pregnancy Medicaid) on receipt of outpatient care during the perinatal period.
This retrospective cohort study compared outpatient visits using linked birth certificate and Medicaid claims from all Medicaid births in Oregon and South Carolina from 2014 through 2019. Pregnancy Medicaid ended 60 days postpartum during the study. Our primary outcome was average number of outpatient visits per 100 beneficiaries each month during three perinatal time points: preconceputally (three months prior to conception), prenatally (9 months prior to birthdate) and postpartum (from birth to 12 months).
Among 105,808 Medicaid-covered births in Oregon and 141,385 births in South Carolina, pregnancy Medicaid was the most prevelant categorical eligibility. Traditional Medicaid recipients had a higher average number of preconception, prenatal and postpartum visits as compared to those in pregnancy Medicaid.
In South Carolina, those using traditional Medicaid had 450% more preconception visits and 70% more postpartum visits compared with pregnancy Medicaid. In Oregon, those using traditional Medicaid had 200% more preconception visits and 29% more postpartum visits than individuals using pregnancy Medicaid. Lack of coverage in both the preconception and postpartum period deprive women of adequate opportunities to access health care or contraception. Changes to pregnancy Medicaid, including extended postpartum coverage through the American Rescue Plan Act of 2021, may facilitate better continuity of care.
在传统医疗补助和孕期医疗补助这两个主要的医疗补助资格类别中，孕妇受益人的护理获取途径存在差异，尤其是在受孕前和产后阶段。孕期医疗补助的资格收入限制高于传统医疗补助，但仅在怀孕期间和怀孕后有限的时间内提供保障。我们的目标是确定医疗补助类型（传统医疗补助和孕期医疗补助）与围产期门诊护理获得情况之间的关联。
本回顾性队列研究比较了俄勒冈州和南卡罗来纳州所有医疗补助分娩者在 2014 年至 2019 年期间的出生证明和医疗补助索赔记录中的门诊就诊情况。在研究期间，孕期医疗补助在产后 60 天结束。我们的主要结局是每个月每 100 名受益人在三个围产期时间点的门诊就诊次数：受孕前（受孕前三个月）、产前（出生前九个月）和产后（从出生到 12 个月）。
在俄勒冈州的 105808 例医疗补助覆盖分娩和南卡罗来纳州的 141385 例分娩中，孕期医疗补助是最常见的类别资格。与孕期医疗补助相比，传统医疗补助的受益人的受孕前、产前和产后就诊次数平均更高。
在南卡罗来纳州，与孕期医疗补助相比，使用传统医疗补助的人受孕前就诊次数增加了 450%，产后就诊次数增加了 70%。在俄勒冈州，与使用孕期医疗补助的人相比，使用传统医疗补助的人受孕前就诊次数增加了 200%，产后就诊次数增加了 29%。在受孕前和产后阶段都缺乏保障，使妇女无法获得足够的医疗保健或避孕机会。通过 2021 年《美国救援计划法案》对孕期医疗补助的修改，包括延长产后保障，可能会促进更好的护理连续性。
