Comparison of Postpartum Health Care Use and Spending Among Individuals with Medicaid-Paid Births Enrolled in Continuous Medicaid vs Commercial Insurance

• Published in: JAMA network open 2022-03, Vol.5 (3), p.e223058
• Main Authors: Gordon, Sarah H, Hoagland, Alex, Admon, Lindsay K, Daw, Jamie R
• Format: Article
• Language: English
• Subjects: Adult; Births; Cross-Sectional Studies; Ethnicity; Female; Health Expenditures; Health Policy; Humans; Insurance Coverage; Medicaid; Online Only; Original Investigation; Postpartum Period; Pregnancy; Primary care; United States
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.3058

Postpartum Medicaid eligibility extensions are likely to shift enrollees from commercial to Medicaid coverage in the postpartum year; however, the potential implications for health care use and spending are unknown. To compare health care use and spending among individuals with a Medicaid-paid birth who had continuous Medicaid vs continuous commercial insurance during months 3 to 12 post partum. Cross-sectional study using linked all-payer claims, birth records, and income data for Medicaid-paid births in the Colorado All Payer Claims Database from 2014 to 2019 to estimate the association between continuous Medicaid vs commercial insurance and health care use and spending during months 3 to 12 post partum. Continuous enrollment in Medicaid vs commercial insurance during months 3 to 12 post partum. Primary outcomes were the rate and number of primary care and outpatient visits, and total out-of-pocket spending during months 3 to 12 post partum. Secondary outcomes were the rate and number of emergency department visits and hospitalizations during months 3 to 12 post partum. The 44 471 individuals in the sample had a mean (SD) age of 26.8 (5.50) years. Self-reported race and ethnicity included 1279 (2.9%) Asian individuals, 4028 (9.1%) Black individuals, 33 534 (75.4%) White individuals, as well as 5630 (12.7%) individuals of other race and ethnicity (American Indian or Alaskan Native; Other Pacific Islander; and unspecified). Of these, 19 337 (43.5%) self-identified as Hispanic individuals. The sample included 42 989 individuals continuously enrolled in Medicaid and 1482 individuals continuously enrolled in commercial insurance during months 3 to 12 post partum. Compared with those continuously enrolled in Medicaid, commercially insured enrollees were older (32.2% of commercial enrollees were between the ages of 30-39 vs 27.5% of Medicaid enrollees, P