Postpartum Medicaid Eligibility and Racial-Ethnic Disparities in Mental Health Treatment

• In Event: Racialized Bias in Health, Education, and Employment

Abstract

Introduction
Insurance coverage in the postpartum period is a key determinant of access to care for postpartum mood and anxiety disorders (PMAD). While Medicaid postpartum extensions represent a significant policy shift, it remains unclear whether extended postpartum Medicaid coverage reduces racial and ethnic disparities in mental health treatment utilization.Purpose
Evaluate how Medicaid postpartum eligibility retention affects racial and ethnic disparities in PMAD treatment utilization.

Data
110,965 Medicaid-paid births identified from the 2014-2019 Colorado All-Payer Claims Database, linked with birth records and individual-level income data.

Research Design
From 2014-2019, pregnant people with incomes ≤265% FPL are eligible for Medicaid coverage through 60 days postpartum. After 60 days, only pregnant people with incomes below 138% FPL were eligible to remain enrolled. Those with incomes between 139-265% lost eligibility and were required to find alternative health insurance or become uninsured. This analysis employs a fuzzy regression discontinuity design (RDD) to compare racial and ethnic disparities in rates of PMAD treatment among pregnant people with incomes just above 138% FPL, who are not eligible to maintain Medicaid coverage beyond 60 days postpartum and enroll in commercial insurance, versus those with incomes just below 138% FPL, who stay enrolled in Medicaid beyond 60 days postpartum.

Results:
Remaining in Medicaid as opposed to transitioning to commercial insurance was associated with a 12.6 percentage point increase in outpatient mental health visit rates among White non-Hispanic mothers (95% CI: 8.6, 16.7; p<0.001), an 11 percentage point increase among Black non-Hispanic mothers (95% CI: 2.2, 19.8; p=0.014), and a 8.8 percentage point increase among mothers of other non-Hispanic ethnicity (95% CI: 0.8, 16.8; p=0.032), but was not statistically associated with increased outpatient mental health visit rates among Hispanic (2.1 pp; 95% CI: −4.2, 8.4; p=0.509) or Asian non-Hispanic individuals (1.7 pp; 95% CI: −4.5, 7.9; p=0.591). Remaining in Medicaid (vs transitioning to commercial coverage) was associated with higher rates of prescription medication treatment among White non-Hispanic (23.1 pp; 95% CI: 16.3, 29.9; p<0.001), Hispanic (18.9 pp; 95% CI: 8.9, 28.9; p<0.001), and Other-race non-Hispanic individuals (18.9 pp; 95% CI: 6.2, 31.5; p=0.003), with no statistically significant changes among Black non-Hispanic (2.1 pp; 95% CI: −10.5, 14.7; p=0.745) or Asian non-Hispanic individuals (−2.6 pp; 95% CI: −13.4, 8.2; p=0.640). Remaining in Medicaid was also associated with higher treatment continuity (≥3 visits or fills) among White non-Hispanic (27.3 pp; 95% CI: 21.5, 33.1; p<0.001), Hispanic (13.5 pp; 95% CI: 5.4, 21.6; p=0.001), and Other-race non-Hispanic individuals (23.5 pp; 95% CI: 13.2, 33.7; p<0.001), while estimates for Black non-Hispanic (10.0 pp; 95% CI: −0.4, 20.4; p=0.060) and Asian non-Hispanic individuals (−0.8 pp; 95% CI: −9.3, 7.7; p=0.861) were not statistically significant.

Conclusion:
Remaining enrolled in Medicaid was associated with increased postpartum mental health treatment, with marked racial and ethnic variation by treatment modality, with significant increases for White non-Hispanic individuals and more limited or non-significant changes for Black and Asian non-Hispanic individuals, particularly for prescription medication for mood or anxiety disorders, and continuity of mental health care.

Author

• Nigel Deen, Boston University
  Presenting Author