The healthcare challenges awaiting women who’ve given birth can sometimes be more problematic than those they faced during pregnancy and labor. And documented and undocumented immigrants too often go without the type of public healthcare—such as Medicaid—that would provide postpartum treatment, according to a study in JAMA Network.
Medicaid covers about 4 in 10 births in the U.S. Researchers from Brown University concluded that “compared with states without insurance restrictions, immigrants living in states with public insurance restrictions were less likely to receive postpartum care.”
That puts this population at greater risk of maternal mortality, as 30% of pregnancy-related deaths occur between six weeks and one year after childbirth, often for very treatable conditions like depression and hypertension.
Researchers looked at 72,981 live births across 19 states between 2012 and 2019. Of those states, six offered full coverage, nine offered moderate coverage and four offered no coverage.
The authors defined full coverage states as those offering full postpartum coverage regardless of immigration status, moderate coverage as states offering coverage to documented immigrants who’d lived in the U.S. at least five years—but not to undocumented immigrants—and no coverage as states that did not offer publicly funded care to documented immigrants who’d hadn’t been in the U.S. for five years nor to undocumented immigrants.
Compared to states that offered full coverage, obtaining postpartum care for immigrants was 7 percentage points lower in states that offered moderate care and 11.3 percentage points lower in states with no postpartum care for documented immigrants who’d hadn’t resided in the U.S. for at least five years and undocumented immigrants.
Researchers note that the American Rescue Plan Act of 2021 extended Medicaid postpartum coverage from 60 days to 12 months, and that might have implications for immigrant healthcare. According to the Kaiser Family Foundation’s Medicaid Postpartum Coverage Extension Tracker, as of July 13, 41 states and the District of Columbia have either implemented the extension or plan to do so.
However, the JAMA Network study notes that the law does not apply to undocumented immigrants, although individual states can take that step. Seven states have: California, Illinois, Maryland, Massachusetts, Minnesota, Rhode Island and Washington, according to the study.
“Excluding undocumented immigrants from the 12-month extension in other states will likely exacerbate existing disparities in insurance coverage and healthcare access between nonimmigrants and undocumented immigrants,” the study states.
Researchers were able to link state pregnancy surveillance data with birth certificate data, allowing them to document postpartum care among low-income immigrants, something that hadn’t been done before beyond the state level.
In addition, they reviewed state policies to measure the availability of postpartum care for undocumented and recently documented immigrants.
The study notes that the postpartum doctor visit is often used to “identify and refer patients for ongoing chronic disease care. Missed opportunities for the treatment and management of chronic health conditions could have important implications for the long-term health of these immigrant parents and birth outcomes for any future pregnancies.”