Study: Medicaid expansion states saw declines in postpartum hospitalizations

Medicaid expansion led to a 17% decline in postpartum hospitalizations as the Biden administration makes moves to boost maternal health, a new study found. 

The study, published Monday in the journal Health Affairs, explores the rates for postpartum hospitalizations from 2010 through 2017 and compared states that expanded Medicaid under the Affordable Care Act (ACA). Federal data have shown that Medicaid covers 4 in 10 births in the U.S.

“Our findings indicate that expanding Medicaid coverage led to improved postpartum health for low-income birthing people,” according to the study. 

Researchers looked at data from 2010 through 2017 from four states that expanded Medicaid (Iowa, New Mexico, Washington and Maryland) and compared them against four states that did not (Florida, Mississippi, Georgia and Utah).

The ACA’s Medicaid expansion went into effect in 2014, so researchers explored postpartum hospitalizations before and after it started. 

The study explored hospitalizations for 60 days after a woman gives birth and 61 days to six months postpartum. 

It found a 17% reduction in hospitalizations during the first 60 days postpartum in expansion states compared to those that did not expand. The study also found some evidence of a smaller decline in hospitalizations from 61 days to six months. 

“This is notable, given that Medicaid pregnancy coverage only expires after sixty days,” the study said. “One potential explanation for this finding is that expanded Medicaid may affect postpartum outcomes by increasing coverage and access to care before pregnancy.”


BCBSA study: Maternal health disparities exist across commercial, Medicaid populations

Prior studies have shown that greater coverage during pregnancy can help avoid or “better manage conditions that may otherwise lead to postpartum hospitalizations,” researchers wrote. 

Medicaid covered postpartum care for 60 days for mothers during the study period. Expanded Medicaid could be “important for early decisions regarding postpartum care during the 60 days,” the study said. 

The 2021 American Rescue Plan Act expanded postpartum care for Medicaid to a full year for any state that asks for it. As of Dec. 8, 27 states and the District of Columbia implemented the extension, and another seven states are hoping to implement an extension, according to data from the Kaiser Family Foundation.

The study said that it is possible that the postpartum extension could help improve the drop in hospitalizations. 

“Under this policy, coverage is automatic for people with pregnancy Medicaid, and income eligibility thresholds for pregnancy coverage surpass the 138 percent of poverty under the ACA Medicaid expansions,” the study said. 

The results come as the Biden administration has rolled out several policies and reforms aimed at improving maternal health. Chief among them is an initiative by the Centers for Medicare & Medicaid Services to add a “birthing friendly” designation for hospitals on the hospital compare website.