Medicaid extensions and postpartum follow-up after pregnancy complications: an interrupted time series analysis

• In Event: Medicaid Policy Levers in Maternal and Child Health: Enrollment, Services, and Access

Abstract

Introduction/Background: Postpartum Medicaid extension policies aim to increase healthcare access and reduce maternal morbidity and mortality. Women with hypertensive disorders in pregnancy (HDP) and diabetes in pregnancy (DIP) may benefit from extended postpartum coverage.

Purpose/Research Question: We tested whether continuous postpartum Medicaid coverage in two states (TX and NY), with different underlying Medicaid coverage policies, increased postpartum screenings and outpatient utilization among women with HDP or DIP.

Methods: We used 2019-2023 TX and NY State Medicaid data to conduct parallel interrupted time series analyses using segmented linear regression. We included Medicaid beneficiaries aged 19-55 who had a live or stillbirth delivery, were eligible for postpartum extensions, and experienced HDP or DIP during pregnancy (NY=137,830, TX=187,328). The pre-policy period was 1/1/19-12/31/19. The 1st post-policy period (1/1/2020-3/31/22) began with deliveries that were eligible for continuous Medicaid coverage as part of the Families First Coronavirus Response Act (FFCRA). The 2nd post-policy period (TX, 4/1/22-8/30/23; NY, 4/1/22-3/31/23) included deliveries for which FFCRA expired within 12 months postpartum, and “unwinding” (TX) or legislated extension (NY) began. In NY, we examined a 3rd post-policy period marking legislated extension period (4/1/23 -12/31/23). We used outpatient diagnosis and procedure codes to define diabetes screening, National Drug Codes to define hypertensive medication, and categorized outpatient visits as any vs. none. Covariate-adjusted models included age and comorbidity index.

Results/Findings: In the pre-policy period, among individuals with DIP, 60% (NY) / 41% (TX) had a postpartum diabetes screen, and 87% (NY) / 66% (TX) had an outpatient visit within 12 months postpartum. Among individuals with HDP in the pre-period, 34% (NY) / 27% (TX) received hypertension medication, and 88% (NY) / 67% (TX) had an outpatient visit. After FFRCA started, adjusted models indicated diabetes screening immediately increased 13.1 percentage points (pp) in TX (95%CI= 11.4, 14.9 ) then trended upward (0.3 pp increase biweekly, 95%CI= 0.2, 0.4), and trended downward during unwinding (-0.3 pp decrease biweekly, 95% CI=-0.4, -0.3). In NY, screening initially increased  5.0 pp (95%CI=3.2, 6.8 ), then was followed by a 0.3 pp biweekly increase in screening (95%CI=0.2, 0.4), and continued to increase throughout the 2nd and 3rd post-policy periods. In this same group, outpatient utilization increased in TX (beta= 10.4 pp, 95%CI= 8.9, 12.0 ) during continuous coverage then decreased during unwinding (-0.3  pp /biweekly, 95%CI= -0.3, -0.2). In NY utilization increased in the 1st  post period, and then began to level off (4.4  pp in 1st post-period, 95%CI=3.3, 5.5 ; 3.9  pp in 2nd post-period, 95%CI=2.3, 5.5 ,  3.5 pp in 3rd post-period, 95%CI= 1.3, 5.7 ). No increases in hypertension medication were found in NY, while TX gained 3.6 pp (95% CI=2.3, 4.9) during continuous coverage and trended upward (beta=0.2 pp, 95% CI=0.1, 0.2) during unwinding.  Outpatient utilization gains among individuals with HDP were similar to individuals with DIP.

Conclusions/Implications: Extended Medicaid coverage increases 12-month screening and outpatient utilization among women with pregnancy complications. These findings suggest that 12-month postpartum Medicaid extensions may help to increase access to healthcare and improve maternal health.

Author

• Renata Howland, New York University
  Presenting Author