Ejughemre Ufuoma, Lyu Wei, Wehby George L
Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA.
Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Health Serv Res. 2025 Jun;60(3):e14395. doi: 10.1111/1475-6773.14395. Epub 2024 Oct 14.
The 2020 Family First Coronavirus Response Act (FFCRA) extended Medicaid coverage for enrollees without rechecking eligibility. Before that, women were eligible for Medicaid coverage up to 60 days postpartum. We examine the FFCRA's effect on Medicaid postpartum coverage, depression symptoms, and birth control use beyond 60 days after delivery.
We use data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS). The primary sample includes 56,828 women who were income eligible up to 60 days postpartum or beyond in their state.
We employ a difference-in-differences design comparing outcomes before and after the FFCRA between women who were not income eligible for Medicaid coverage beyond 60 days postpartum in their state and those who were income eligible. We estimate models without and with controlling for state-specific trends in outcomes over time.
DATA COLLECTION/EXTRACTION METHODS: N/A.
There is an 8.1 percentage-point increase in the likelihood of having Medicaid coverage without controlling for state-specific trends, and 5.4 percentage-points when controlling for state-specific trends (both p < 0.05). There is a decline in likelihood of being uninsured by 3 percentage-points (p < 0.05) without state-specific trends and a smaller and non-significant decline when including state-specific trends. Estimated effects on depression symptoms and birth control use are small and statistically non-significant.
Following the FFCRA, there was an increase in Medicaid coverage beyond 60 days postpartum among women who would have been income ineligible for Medicaid after 60 days. However, there is a less pronounced effect on likelihood of being uninsured, which might be partly due to some switching from private to Medicaid coverage. There were no discernable effects on depression symptoms and birth control use. Examining additional health and health care utilization measures over a longer postpartum period is needed to further understand the FCCRA effects on these outcomes.
2020年《家庭第一冠状病毒应对法案》（FFCRA）扩大了医疗补助覆盖范围，且未重新核查参保资格。在此之前，女性在产后60天内有资格享受医疗补助。我们研究了FFCRA对医疗补助产后覆盖范围、抑郁症状以及产后60天之后的避孕措施使用情况的影响。
我们使用了2016 - 2021年妊娠风险评估监测系统（PRAMS）的数据。主要样本包括56828名女性，她们在本州产后60天内或更长时间符合收入资格标准。
我们采用了双重差分设计，比较FFCRA实施前后，本州产后60天以上不符合医疗补助收入资格标准的女性与符合收入资格标准的女性之间的结果。我们估计了未控制和控制了随时间变化的州特定趋势的模型。
数据收集/提取方法：无。
在未控制州特定趋势时，获得医疗补助覆盖的可能性增加了8.1个百分点；在控制州特定趋势时，增加了5.4个百分点（两者p < 0.05）。在未考虑州特定趋势时，未参保的可能性下降了3个百分点（p < 0.05），而在纳入州特定趋势时，下降幅度较小且无统计学意义。对抑郁症状和避孕措施使用的估计影响较小且无统计学意义。
FFCRA实施后，产后60天以上原本不符合医疗补助收入资格的女性中，医疗补助覆盖范围有所增加。然而，对未参保可能性的影响不太明显，这可能部分归因于一些人从私人保险转为医疗补助覆盖。对抑郁症状和避孕措施使用没有明显影响。需要在更长的产后时期检查更多的健康和医疗利用指标，以进一步了解FFCRA对这些结果的影响。
