Coverage churn threatens health of expectant, new mothers

Coverage disruptions can jeopardize access to timely prenatal and postpartum care—both critical to ensure the health of mother and infant. (Getty/byryo)

Though transitioning in and out of health insurance coverage in the months surrounding childbirth can negatively affect health outcomes, new research suggests that is a reality for many women.

The study, published in this month’s issue of Health Affairs, notes that changes in employment, income, and program eligibility that tend to accompany childbirth can make women vulnerable to insurance disruptions during this time. That can jeopardize their access to timely prenatal and postpartum care—both critical to ensure the health of mother and infant. 

To better understand coverage churn among expectant and new mothers, researchers examined nationally representative survey data from 2005 to 2013.

RELATED: The 2017 enrollment period saw impressive churn. Here's what that looks like

Here’s a rundown of the study’s findings:

  • Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month they delivered. However, 55% of women with that coverage at delivery experienced a coverage gap in the next six months.
  • In the nine months leading up to and including their delivery month, 58% of women experienced at least one change in insurance status, and 62% were uninsured for at least one month.
  • The lowest rate of uninsurance, 13%, was in the month of delivery, but after delivery, the rate rose “rapidly” to 23%, nearly reaching the overall prepregnancy rate of 25%. “This suggests that many women have no other accessible source of coverage when pregnancy-related Medicaid coverage ends sixty days after delivery,” the study notes.
  • Factors associated with having a lapse in insurance include not being married, not speaking English at home, having Medicaid or CHIP coverage at delivery (rather than private or other coverage), living in the South and having an income of 100% to 185% of the federal poverty level.

There are promising signs that Medicaid expansion under the Affordable Care Act can improve continuity of coverage for low-income women, the study notes. But coverage churn will remain a concern in the nonexpansion states and could worsen if Medicaid expansion is rolled back.  

“Pregnancy and the postpartum period are really important times for investing in the health of women and children," Benjamin Sommers, associate professor of health policy and economics at Harvard Chan School and senior author of the study, said in an announcement. "Our study shows there’s a major need to improve continuity of coverage during this period, especially for lower-income women."

States therefore might want to consider revising Medicaid or CHIP eligibility criteria to explicitly recognize the transition from pregnancy to parenthood, as well as increasing outreach efforts to help smooth the transition from pregnancy-related Medicaid coverage, the study says.