While Medicaid covers women as they give birth, it ends 60 days afterward, and many women have no coverage alternative. Forty percent of births take place in states that did not expand Medicaid.
Gaining health coverage just before giving birth—and losing it again afterward—isn’t good for women or their children. But a new study appearing in Health Affairs finds this happens frequently, especially among minority women.
Researchers from the Harvard T.H. Chan School of Public Health examined month-to-month health insurance coverage in the months before, during, and after childbirth. To no surprise, the highest rates of coverage happened at delivery. However, many of these women were insured through Medicaid or the Children’s Health Insurance Program (CHIP), which was no guarantee of coverage before or after childbirth.
More than two-third (65%) of the women covered by these programs at delivery were without insurance for at least 1 month while they were pregnant, and 55% had a coverage gap of at least 1 month during the first 6 months of the baby’s life. These gaps can put both mother and baby at risk; since undiagnosed conditions could affect pregnancy—and new mothers are at risk of postpartum depression.
The March of Dimes specifically recommends that women get a checkup before trying to conceive, update their vaccinations, see a dentist, follow a healthy diet, and start taking prenatal vitamins.
Researchers examined data from more than 2700 women who took part in the Medical Expenditure Panel Survey during the years 2005 to 2013. This period covers the years before full implementation of the Affordable Care Act, so it is likely that insured rates for new mothers increased somewhat in the years afterward due to Medicaid expansion. However, the researchers noted that 40% of the births occur in states that have not expanded Medicaid, highlighting the vulnerability of low-income women.
A recent proposal from House Republicans would have phased out Medicaid expansion and cut overall funding by 25%. The proposal also called for requiring new mothers on Medicaid to seek work after 60 days to stay covered.
“Ideally, every woman would have access to coverage not only for prenatal care and delivery, but also for preconception and extended postpartum care,” Jamie Daw, the study’s lead author and a doctoral student in health policy, said in a statement. "We find there is much more work to be done to ensure that women retain continuous coverage for services we know are critical for reducing adverse birth outcomes and supporting the health of moms and babies."
Keeping health coverage after childbirth is a major challenge, the study found. Nearly half of all women in the study lost health coverage for at least 1 month in the first 6 months after giving birth. Traditional Medicaid coverage ends 60 days after women give birth, and many have trouble finding an alternative. Those who lost coverage in the early months after delivery were more likely to be unmarried, to not speak English at home, and to live in the South.
Incomes for this group tended to fall between 100% and 185% of the federal poverty level; states with Medicaid expansion cover households up to 138% of the federal poverty level.
“Pregnancy and the postpartum period are really important times for investing in the health of women and children,” said senior author Benjamin Sommers, MD, PhD, an associate professor at Harvard. “Our study shows there’s a major need to improve continuity of coverage during this period, especially for lower-income women. The ACA may be helping address this problem, but more research is needed to measure the law’s impact."
Daw JR, Hatfield LA, Swartz K, Sommers BD. Women In the United States experience high rates of coverage ‘churn’ in months before and after dhildbirth [published online April 3, 2017]. Health Affairs. 2017; doi: 10.1377/hlthaff.2016.1241