Extended Medicaid coverage increases postpartum care for high-risk women

Extending Medicaid coverage to 12 months after childbirth increased postpartum health care utilization among women with pregnancy complications such as diabetes and hypertension, according to a new study at Columbia University Mailman School of Public Health. The findings suggest that expanded postpartum Medicaid coverage can be leveraged to improve access to preventive care and reduce both immediate postpartum complications and long-term maternal health risks.

The study is among the first to examine whether expanded postpartum Medicaid coverage translates into greater use of recommended postpartum screenings and outpatient care among women at high risk for maternal morbidity and chronic disease. The results are published in the journal Health Affairs Scholar.

Postpartum health care plays a key role for women with pregnancy complications such as diabetes or hypertension. Screening for unresolved conditions, monitoring for emerging chronic disease, and establishing ongoing preventive care are all critical during this period. Additionally, connecting women to primary care can have lasting benefits for their health."

Teresa Janevic, PhD, Associate Professor of Epidemiology and corresponding author

Women who experience diabetes in pregnancy (DIP) or hypertensive disorders of pregnancy (HDP) face elevated risks of postpartum emergency department visits, severe maternal morbidity, pregnancy-related death, and the later development of diabetes and cardiovascular disease. Yet postpartum follow-up remains persistently low, in part because many women historically lost Medicaid coverage just 60 days after giving birth. The American College of Obstetricians and Gynecologists (ACOG) recommends ongoing postpartum care beyond a single six-week visit.

To determine whether extending Medicaid coverage improves care, researchers analyzed Medicaid claims from more than five years of births in New York and Texas, examining deliveries between 2019 and 2023. The study included women covered through pregnancy-related Medicaid, traditional Medicaid, and, in New York, Emergency Medicaid. Researchers also included women with preexisting diabetes and hypertension, who likewise require postpartum follow-up.

The researchers found that postpartum diabetes screening and outpatient visits increased during the COVID-19 continuous enrollment provision (CEP), declined during the unwinding of that policy in Texas, and increased again following implementation of 12-month postpartum Medicaid coverage in New York. Prescriptions for antihypertensive medications increased modestly in Texas but showed little change in New York.

Overall, extending Medicaid coverage to 12 months postpartum increased outpatient utilization among women with diabetes or hypertensive disorders of pregnancy in both states. The increases were particularly pronounced in Texas, where baseline rates of postpartum care were lower.

"Given that New York and Texas have large Medicaid populations and represent very different policy environments, the consistency of our findings suggests that extending postpartum Medicaid coverage is an effective strategy to increase follow-up care among Medicaid beneficiaries," said Ellerie Weber, Icahn School of Medicine at Mount Sinai and co-author.

Prior to 2020, most women who qualified for Medicaid because of pregnancy lost coverage just 60 days after delivery, creating a major barrier to recommended postpartum care and referrals to primary and specialty providers. Currently, 49 states and Washington, D.C., have adopted the option to extend Medicaid coverage to 12 months postpartum through the American Rescue Plan Act.

The COVID-19 emergency also created a natural experiment, according to Janevic. During the Continuous Enrollment Provision, states receiving enhanced federal funding were required to maintain Medicaid coverage for enrolled beneficiaries.

"These policy changes provided a unique opportunity to examine whether expanding insurance coverage leads to greater use of recommended postpartum care," Ellerie noted.

The study also builds on previous Columbia Mailman research showing that postpartum Medicaid extensions reduce insurance loss after childbirth. While earlier studies largely focused on insurance coverage itself, this research examined whether expanded coverage resulted in greater use of health care among women most likely to benefit.

"Our findings build on existing evidence by showing that postpartum Medicaid extensions can increase follow-up care among women with common pregnancy complications," said Janevic. "This is a high-risk population with substantial ongoing health care needs, making them particularly likely to benefit from continuous coverage.

"While Medicaid claims cannot tell us whether these changes represent entirely new health care utilization or a shift from commercial insurance or self-pay to Medicaid, the evidence points toward women receiving more postpartum care," noted Ellerie. "Future research will help clarify the extent to which expanded coverage translates into additional care."

The findings are especially timely as states prepare for federal Medicaid policy changes under the One Big Beautiful Bill Act, which could reduce Medicaid enrollment through new work requirements, more frequent eligibility reviews, and changes affecting immigrant coverage. The researchers say their findings underscore the importance of maximizing the benefits of existing postpartum Medicaid extensions to improve maternal health outcomes.

"Health systems should take advantage of extended postpartum Medicaid coverage to expand follow-up care for women with diabetes and hypertensive disorders of pregnancy," said Janevic. "Doing so has the potential to improve both postpartum health and long-term prevention of chronic disease."