Swartz Jonas J, Lawson Avis Ashley, Bundorf M Kate, Domino Marisa Elena
Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, North Carolina.
Duke-Margolis Institute for Health Policy, Durham, North Carolina.
JAMA Health Forum. 2025 Jun 7;6(6):e251630. doi: 10.1001/jamahealthforum.2025.1630.
The American Rescue Plan of 2021 allowed states to expand pregnancy Medicaid coverage to 12 months post partum. How the new policy affects Medicaid coverage and health care utilization is largely unknown.
To quantify insurance coverage and care utilization for postpartum individuals under Medicaid policies that extended postpartum coverage to 12 months after delivery from 60 days.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of Medicaid coverage and utilization in North Carolina using Medicaid claims from March 2016 to December 2023 was conducted. All Medicaid-funded births in North Carolina from January 2017 through December 2022 were included.
A total of 3 periods were differentiated: before the COVID-19 public health emergency (PHE), during the PHE when there was a moratorium on Medicaid disenrollment, and after North Carolina adopted the 12-month postpartum extension through the American Rescue Plan of 2021.
Length and type of postpartum Medicaid enrollment were evaluated. Utilization outcomes included indicators of (1) the receipt of at least 1 postpartum visit; (2) any contraceptive visit; (3) any primary care visit; (4) any outpatient mental health care, and (5) any outpatient substance use disorder (SUD) care.
There were 353 957 Medicaid-funded births in North Carolina from January 2017 through December 2022. During the postpartum extension, Medicaid recipients were more likely to have been continuously covered by comprehensive Medicaid at 12 months post partum (97.1% vs 26.5% pre-PHE). Beneficiaries in the extended coverage cohorts were substantially more likely to use Medicaid-financed care than those in the pre-PHE cohort for contraception (47.8% for the PHE cohort and 47.9% for the extension cohort vs 38.0% for the pre-PHE cohort), primary care (68.1% for the PHE cohort and 71.4% for the extension cohort vs 25.3% for the pre-PHE cohort), mental health (22.1% for the PHE cohort and 25.7% for the extension cohort vs 7.5% for the pre-PHE cohort) and substance use disorder visits (3.6% for the PHE cohort and 5.3% for the extension cohort vs 2.2%for the pre-PHE cohort) within 12 months, although there was evidence of delays in early postpartum and contraceptive visits.
Results of this study suggest that extending Medicaid coverage for 12 months post partum was associated with expanded opportunities for greater access to Medicaid-financed medical and behavioral health care. Both prevention and ongoing treatment of chronic conditions may help mitigate key adverse outcomes. Findings may help policymakers and public health officials understand how extended coverage affects access to Medicaid-financed care.
2021年的《美国救援计划》允许各州将孕期医疗补助覆盖范围扩大到产后12个月。这项新政策如何影响医疗补助覆盖范围和医疗保健利用率在很大程度上尚不清楚。
量化在将产后覆盖范围从分娩后60天延长至12个月的医疗补助政策下，产后人群的保险覆盖情况和医疗服务利用情况。
设计、设置和参与者：利用2016年3月至2023年12月的医疗补助理赔数据，对北卡罗来纳州的医疗补助覆盖情况和利用情况进行了一项回顾性研究。纳入了2017年1月至2022年12月在北卡罗来纳州所有由医疗补助资助的分娩案例。
总共区分了3个时期：新冠疫情公共卫生紧急事件（PHE）之前、PHE期间（当时暂停了医疗补助退保）以及北卡罗来纳州通过2021年《美国救援计划》采用12个月产后延期政策之后。
评估了产后医疗补助登记的时长和类型。利用结局指标包括：（1）至少接受1次产后就诊；（2）任何避孕就诊；（3）任何初级保健就诊；（4）任何门诊心理健康护理，以及（5）任何门诊物质使用障碍（SUD）护理。
2017年1月至2022年12月，北卡罗来纳州有353957例由医疗补助资助的分娩。在产后延期期间，医疗补助受助人在产后12个月更有可能持续获得全面医疗补助覆盖（97.1%，而PHE之前为26.5%）。与PHE之前队列相比，延长覆盖队列中的受益人在避孕（PHE队列中为47.8%，延长队列中为47.9%，而PHE之前队列为38.0%）、初级保健（PHE队列中为68.1%，延长队列中为71.4%，而PHE之前队列为25.3%）、心理健康（PHE队列中为22.1%，延长队列中为25.7%，而PHE之前队列为7.5%）和物质使用障碍就诊（PHE队列中为3.6%，延长队列中为5.3%，而PHE之前队列为2.2%）方面在12个月内更有可能使用医疗补助资助的护理，尽管有证据表明产后早期就诊和避孕就诊存在延迟。
本研究结果表明，将医疗补助覆盖范围延长至产后12个月与获得更多医疗补助资助的医疗和行为健康护理的机会增加有关。慢性病的预防和持续治疗都可能有助于减轻关键的不良结局。研究结果可能有助于政策制定者和公共卫生官员了解延长覆盖范围如何影响获得医疗补助资助护理的机会。
