While many pregnant women gain coverage through Medicaid, ensuring they have insurance after giving birth remains a significant challenge, according to a new study.
Researchers at the Urban Institute, a left-leaning think tank, found that 26.8% of new mothers covered for prenatal care through Medicaid were uninsured prior to becoming pregnant. In addition, 21.9% became uninsured again within two to six months of their child's birth, the study found.
The study is based on Medicaid coverage data from 2015 to 2018 across 43 states, including 27 that expanded Medicaid under the Affordable Care Act, that participate in the Pregnancy Risk Assessment Monitoring System (PRAMS). Overall, 34.5% of the mothers in the study were uninsured either before or after giving birth, according to the study.
"Women experiencing uninsurance both preconception and postpartum indicates a lack of accessible public and private coverage options outside of pregnancy," the researchers wrote. "These women may temporarily benefit from a postpartum extension but would likely need additional support to maintain coverage after it expires and before any subsequent pregnancy."
The study found higher rates of women without coverage in states that did not expand Medicaid and among Hispanic women who filled out the PRAMS survey in Spanish.
The researchers said that the difference in insurance rates between new Black and White mothers was smaller and that boosting coverage wouldn't necessarily tackle high rates of maternal mortality among Black women.
The study also points to key policy implications for ensuring women gain coverage for the long term. For one, pregnancy clearly brings many women into the Medicaid program, who then stay covered after giving birth. These women could use more targeted outreach to get them covered earlier.
"In non-expansion states, women experiencing preconception-only uninsurance could benefit from take-up of the ACA Medicaid expansion," they said. "In all states, outreach and enrollment efforts for subsidized Marketplace coverage could help women not eligible for Medicaid identify affordable coverage options."
For women who lose coverage post-partum, they could have previously been enrolled in employer-based plans that they dropped out of, or they faced challenges enrolling into other types of Medicaid coverage if eligible, the study says.
"An extension of postpartum Medicaid eligibility to a full year postpartum could help such women maintain coverage during the critical 'fourth trimester' and provide a longer period to return to work and employer coverage or to manage enrollment paperwork and transition to parental Medicaid or Marketplace coverage," the researchers wrote.