# Postpartum Medicaid Use in Birthing Parents and Access to Financed Care

## TL;DR

Extending Medicaid coverage for 12 months after childbirth in North Carolina increased access to health care services like contraception, mental health, and primary care.

## Contribution

This study provides empirical evidence on how extended postpartum Medicaid coverage affects health care utilization in birthing parents.

## Key findings

- Extended coverage led to 97.1% of beneficiaries remaining enrolled at 12 months postpartum, compared to 26.5% before the policy change.
- Utilization of Medicaid-financed care for contraception, primary care, and mental health significantly increased under the 12-month extension.
- Substance use disorder care visits also rose, though early postpartum and contraceptive visits showed some delays.

## Abstract

Is 12 months of postpartum Medicaid coverage in North Carolina provided to birthing parents associated with greater access to Medicaid-financed health care?

In this cohort study of 353 957 Medicaid-funded births in North Carolina, extended postpartum Medicaid coverage programs was associated with prolonged enrollment to at least 12 months for the more than 95% of affected beneficiaries. This facilitated covered visits for contraceptive care, primary care, mental health care, and substance use disorder.

In this study, a 12-month postpartum Medicaid coverage program was associated with improved Medicaid coverage and increased utilization of Medicaid-financed services that potentially could mitigate key adverse outcomes.

The American Rescue Plan of 2021 allowed states to expand pregnancy Medicaid coverage to 12 months post partum. How the new policy affects Medicaid coverage and health care utilization is largely unknown.

To quantify insurance coverage and care utilization for postpartum individuals under Medicaid policies that extended postpartum coverage to 12 months after delivery from 60 days.

A retrospective study of Medicaid coverage and utilization in North Carolina using Medicaid claims from March 2016 to December 2023 was conducted. All Medicaid-funded births in North Carolina from January 2017 through December 2022 were included.

A total of 3 periods were differentiated: before the COVID-19 public health emergency (PHE), during the PHE when there was a moratorium on Medicaid disenrollment, and after North Carolina adopted the 12-month postpartum extension through the American Rescue Plan of 2021.

Length and type of postpartum Medicaid enrollment were evaluated. Utilization outcomes included indicators of (1) the receipt of at least 1 postpartum visit; (2) any contraceptive visit; (3) any primary care visit; (4) any outpatient mental health care, and (5) any outpatient substance use disorder (SUD) care.

There were 353 957 Medicaid-funded births in North Carolina from January 2017 through December 2022. During the postpartum extension, Medicaid recipients were more likely to have been continuously covered by comprehensive Medicaid at 12 months post partum (97.1% vs 26.5% pre-PHE). Beneficiaries in the extended coverage cohorts were substantially more likely to use Medicaid-financed care than those in the pre-PHE cohort for contraception (47.8% for the PHE cohort and 47.9% for the extension cohort vs 38.0% for the pre-PHE cohort), primary care (68.1% for the PHE cohort and 71.4% for the extension cohort vs 25.3% for the pre-PHE cohort), mental health (22.1% for the PHE cohort and 25.7% for the extension cohort vs 7.5% for the pre-PHE cohort) and substance use disorder visits (3.6% for the PHE cohort and 5.3% for the extension cohort vs 2.2%for the pre-PHE cohort) within 12 months, although there was evidence of delays in early postpartum and contraceptive visits.

Results of this study suggest that extending Medicaid coverage for 12 months post partum was associated with expanded opportunities for greater access to Medicaid-financed medical and behavioral health care. Both prevention and ongoing treatment of chronic conditions may help mitigate key adverse outcomes. Findings may help policymakers and public health officials understand how extended coverage affects access to Medicaid-financed care.

This cohort study assesses whether 12 months of postpartum Medicaid coverage in North Carolina provided to birthing parents was associated with greater access to Medicaid-financed health care.