Eliason Erica L, Gordon Sarah H, Steenland Maria W
Center for State Health Policy, Rutgers University, New Brunswick, New Jersey, USA.
Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey, USA.
Health Serv Res. 2025 Aug;60(4):e14618. doi: 10.1111/1475-6773.14618. Epub 2025 Mar 26.
To examine the impact of extended postpartum Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) on self-reported postpartum insurance status among prenatal Medicaid recipients, and differences by state Medicaid expansion status and race, and ethnicity.
We used a global polynomial linear regression discontinuity design (RDD) approach to estimate the effect of extended postpartum Medicaid eligibility during the FFCRA on changes in self-reported postpartum Medicaid, private coverage, and uninsurance. This approach compares individuals who gave birth before FFCRA exposure with those who gave birth during extended postpartum Medicaid eligibility, using birth timing to determine FFCRA exposure. We estimated RDD models overall, by state Medicaid expansion status, and by race and ethnicity.
This study used 2018-2021 Pregnancy Risk Assessment Monitoring System data, a multi-state survey of individuals with a recent live birth, and a sample of prenatal Medicaid recipients age 20 or older in 29 study jurisdictions.
In adjusted RDD models, extended Medicaid eligibility was associated with a 10.7 percentage point (pp) (95% CI: 8.7, 12.6) increase in postpartum Medicaid, a 3.5 pp (95% CI: -5.2, -1.8) decrease in postpartum private coverage, and a 6.5 pp (95% CI: -8.0, -5.0) decrease in postpartum uninsurance. In stratified RDD models, we found larger increases in postpartum Medicaid and larger decreases in uninsurance in non-expansion states than in Medicaid expansion states. In RDD models by race and ethnicity, we found similar increases in postpartum Medicaid and similar decreases in postpartum uninsurance among non-Hispanic Black respondents, Hispanic respondents, and non-Hispanic White respondents.
We found significant improvements in postpartum Medicaid continuity and reductions in uninsurance during extended postpartum Medicaid eligibility. Postpartum Medicaid extensions under the American Rescue Plan could help maintain some coverage gains under the FFCRA.
研究《家庭第一冠状病毒应对法案》（FFCRA）规定的延长产后医疗补助资格对产前医疗补助受助人自我报告的产后保险状况的影响，以及按州医疗补助扩展状况、种族和族裔划分的差异。
我们采用全局多项式线性回归断点设计（RDD）方法，估计FFCRA期间延长产后医疗补助资格对自我报告的产后医疗补助、私人保险覆盖和未参保情况变化的影响。该方法将在FFCRA实施前分娩的个体与在延长产后医疗补助资格期间分娩的个体进行比较，利用分娩时间来确定是否受FFCRA影响。我们总体上、按州医疗补助扩展状况以及按种族和族裔估计了RDD模型。
本研究使用了2018 - 2021年妊娠风险评估监测系统数据，这是一项对近期有活产的个体进行的多州调查，以及29个研究辖区内年龄在20岁及以上的产前医疗补助受助人样本。
在调整后的RDD模型中，延长医疗补助资格与产后医疗补助增加10.7个百分点（pp）（95%置信区间：8.7，12.6）、产后私人保险覆盖减少3.5个百分点（pp）（95%置信区间：-5.2，-1.8）以及产后未参保情况减少6.5个百分点（pp）（95%置信区间：-8.0，-5.0）相关。在分层RDD模型中，我们发现非扩展州产后医疗补助的增加幅度和未参保情况的减少幅度大于医疗补助扩展州。在按种族和族裔划分的RDD模型中，我们发现非西班牙裔黑人受访者、西班牙裔受访者和非西班牙裔白人受访者产后医疗补助的增加幅度相似，产后未参保情况的减少幅度也相似。
我们发现，在延长产后医疗补助资格期间，产后医疗补助的连续性有显著改善，未参保情况有所减少。《美国救援计划》下的产后医疗补助延期有助于维持FFCRA下的一些保险覆盖收益。
