Postpartum Hospitalizations Decrease With Medicaid Expansion

When comparing rates of postpartum hospitalizations between states with and without expanded Medicaid under the Affordable Care Act (ACA), states with expanded coverage saw a 17% reduction in hospitalizations, suggesting that expanding Medicaid may improve postpartum health outcomes among low-income birthing peoples.

This study is the first of its kind to provide evidence of a decrease in postpartum hospitalizations in association with expanded Medicaid. The results were published in Health Affairs.

This study included data from 4 expansion states: Iowa, Maryland, New Mexico, and Washington from 2010-2017 as well as data from 4 non-Medicaid expansion states: Florida, Georgia, Mississippi, and Utah. Data came from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project State Inpatient Databases.

Individuals were aged 19 or older and had a hospital delivery in which the expected primary method of pay was Medicaid.

There were 2 primary outcomes—hospitalization within 60 days of delivery discharge, and hospitalization between 61 days and up to 6 months after discharge. All states cover hospitalizations within the first 60 days in the postpartum period, but only states that expanded Medicaid cover them beyond 60 days.

The analysis was limited to people whose outcomes could be tracked within a calendar year. About 1.34 million individuals had deliveries during the first 3 quarters of each calendar and were analyzed for the 60-day postpartum outcome. A total of 880,014 individuals had deliveries within the first 2 quarters of each calendar year and were analyzed for the 61-day to 6-month postpartum outcome.

Pregnancy or child-birth related hospitalizations represented a much larger share of postpartum hospitalizations within the first 60 days (70%). Hospitalizations after 60 days were 8%, and tended to be gastrointestinal diseases, mental disorders, diseases of the genitourinary system, and injury and poisoning.

States with Medicaid expansion saw a decrease in postpartum hospitalizations within 60 days compared with non-expansion states. Medicaid expansion decreased the rate of 60-day postpartum hospitalizations by 17% (P = 0.052), in which approximately 75% of this decline was attributed to a decrease in childbirth-related hospitalizations.

The authors of the study said their findings were “notable, given that Medicaid pregnancy coverage only expires after 60 days.”

In addition, the study found that "rates of postpartum hospitalization were much higher among non-Hispanic Black people with Medicaid-financed deliveries compared with all other racial and ethnic groups." This group had a rate of postpartum hospitalization during the first 60 days of 2.4%, compared with 1.7% for non-Hispanic White people and 1.5% for Hispanic people.

The researchers of this study acknowledge certain limitations in their analysis, including the small portion of expansion states and the focus on deliveries with postpartum periods occurring within the same year. However, the researchers believe that this study provides evidence that expanded Medicaid coverage can help lessen the rate of postpartum hospitalizations among low-income populations.

“This study’s findings suggest that expanded coverage during the postpartum period in these [Medicaid-expansion] states may lead to reductions in postpartum hospitalizations during the first 6 months after delivery,” wrote the authors. “We found not only evidence of a decrease in 60-day postpartum hospitalizations but also, some evidence suggesting a decrease beyond this period.”

Reference

Steenland MW, Wherry LR. Medicaid expansion led to reductions in Postpartum Hospitalizations. Health Aff (Millwood). 2023;42(1);18-25. doi: 10.1377/hlthaff.2022.00819