# Medicaid Continuous Coverage Requirement and Postpartum Hospitalization

## TL;DR

A study found that extending Medicaid coverage after childbirth was linked to fewer hospitalizations for mothers in states with higher rates of postpartum uninsurance.

## Contribution

The study provides evidence that Medicaid's continuous coverage requirement reduced postpartum hospitalizations in high-uninsurance states.

## Key findings

- Extended Medicaid coverage was associated with a 10.9% decrease in postpartum hospitalizations 61 to 180 days after delivery in high-exposure states.
- The reduction in hospitalization was not significant for the first 60 days postpartum.
- High-exposure states had larger declines in hospitalization rates compared to low-exposure states.

## Abstract

This cohort study assesses the association of the Medicaid continuous coverage requirement with changes in the postpartum hospitalization rate among mothers with Medicaid-paid deliveries.

Was the Medicaid continuous coverage requirement (CCR) associated with changes in the postpartum hospitalization rate among mothers with Medicaid-paid deliveries (based on primary expected payer)?

This cohort study identified 2 024 214 mothers with Medicaid-paid deliveries and found that, after the CCR was implemented, states that had higher rates of postpartum uninsurance before the CCR was implemented had larger declines in hospitalization rates 61 to 180 days post partum.

Findings of this study suggest that extended Medicaid coverage under the CCR was associated with a reduction in the postpartum hospitalization rate for mothers with Medicaid-paid deliveries in states that had higher rates of postpartum uninsurance before the CCR was implemented.

In 2020, all US states adopted the Families First Coronavirus Response Act Medicaid continuous coverage requirement (CCR), which prevented disenrollment from Medicaid. This policy effectively extended pregnancy-related Medicaid eligibility beyond the previous end date of 60 days post partum.

To determine whether the CCR was associated with a change in postpartum hospitalization rates for mothers covered by Medicaid during their delivery.

This cohort study was conducted from December 2023 to March 2025 at all nonfederal acute care hospitals in 20 states using data from the Healthcare Cost and Utilization Project’s State Inpatient Databases from 2018 through 2021. Participants included mothers aged 18 to 55 years who had Medicaid-paid deliveries (based on the primary expected payer) from January 2018 to June 2021; they were followed up for 180 days post partum.

State-level postpartum uninsured rate among mothers with Medicaid-paid deliveries that occurred from 2018 to 2019 (before the CCR was implemented in 2020). Residency in states with an uninsured rate above the median was considered to be high exposure (ie, a greater share of the state population had the potential to benefit from the CCR) and residency in states with a preperiod uninsured rate below the median was considered low exposure.

Probability of a mother being hospitalized 1 to 60 days post partum (covered under previous Medicaid eligibility rules) and 61 to 180 days post partum (newly covered under the CCR).

A total of 2 024 214 mothers (mean age, 27.5 [95% CI, 27.5-27.5] years) with Medicaid-paid deliveries were identified. The sample included 550 881 deliveries by Hispanic mothers (27.2%), 490 586 deliveries by non-Hispanic Black mothers (24.2%), 744 945 deliveries by non-Hispanic White mothers (36.8%), 200 639 deliveries by mothers of other races and ethnicities (9.9%), and 37 163 deliveries by mothers with missing race and ethnicity data (1.8%). Among the full sample, 931 452 mothers (mean age, 27.1 [95% CI, 27.71-27.2] years) resided in high-exposure states and 1 092 762 mothers (mean age, 27.8 [95% CI, 27.8-27.8] years) resided in low-exposure states. In adjusted difference-in-differences models, the rate of hospitalization per 1000 Medicaid-paid deliveries at 61 to 180 days post partum decreased (adjusted β coefficient, −1.4; 95% CI, −2.5 to −0.3) in high-exposure states compared with low-exposure states, a 10.9% decrease relative to the preperiod mean (12.9; 95% CI, 12.6 to 13.2) in high-exposure states. The analogous estimate for the hospitalization rates 1 to 60 days post partum was not statistically significant (−0.7 [95% CI, −2.0 to 0.5] per 1000 Medicaid-paid deliveries).

Findings of this study suggest that residency in high-exposure states was associated with a reduction in hospitalizations for mothers 61 to 180 days post partum (the period newly covered by extended Medicaid coverage). Extended Medicaid coverage may help to improve postpartum health and reduce adverse events among mothers with low income.