Medicaid Policies for Immigrants Enhance Postpartum Insurance Coverage Equity

A recent study conducted by researchers at Columbia University's Mailman School of Public Health highlights the positive impact of Medicaid extension policies that encompass all immigrants in the post-COVID era. This initiative has been linked to a significant decrease in postpartum uninsurance rates, particularly notable in New York City. However, the findings also indicate that there remain awareness gaps that have affected the full benefits for Hispanic immigrants.

The study, published in the American Journal of Public Health, details how continuous Medicaid enrollment, which was facilitated through the Families First Coronavirus Response Act (FFCRA), led to a 4 percentage-point decline in postpartum uninsurance among immigrant populations in New York City. This development, while improving coverage, did not entirely close the insurance gap between immigrant and U.S.-born populations.

Previous research from the same institution indicated that maintaining Medicaid coverage during the FFCRA period reduced uninsurance rates from 10% in 2019 to 3.7% in 2021, alongside increased utilization of preventive postpartum services among Medicaid beneficiaries.

Dr. Teresa Janevic, an associate professor of Epidemiology at Columbia Mailman School, emphasized the importance of not only extending postpartum Medicaid to all immigrants but also implementing community-focused strategies that enhance awareness of coverage options and promote maternal health equity.

The investigation focused on postpartum insurance rates among births covered by Medicaid in New York City, using data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Researchers compared uninsurance rates for women 2 to 6 months postpartum before (2016-2019) and after (2020-2021) the FFCRA implementation. The analysis included 2,611 Medicaid-covered births prior to the FFCRA and 1,197 births from the subsequent period.

Among immigrant populations, postpartum uninsurance decreased from 13.6% to 9.3% following the FFCRA, while rates for U.S.-born individuals dropped from 1.2% to 0.7%. Although there was a decline in uninsurance across all immigrant groups, Hispanic immigrants experienced the smallest reduction, from 23.5% to 18%.

Alarmingly, approximately 1 in 6 Hispanic immigrants reported being uninsured during the FFCRA period, despite being eligible for coverage. Analysis of sociodemographic factors revealed disparities in uninsurance rates based on years of residency in the U.S., race/ethnicity, and educational attainment.

In New York City, Hispanic and Black populations face significantly higher risks of pregnancy-related mortality--2 and 6 times higher, respectively--compared to their non-Hispanic white counterparts. This disparity extends into the postpartum period, with the loss of Medicaid coverage after childbirth likely exacerbating these inequities.

Janevic noted that the findings suggest a critical barrier exists due to a lack of awareness among many Hispanic immigrants regarding their continued eligibility for Medicaid coverage. The COVID-19 pandemic saw a 41% increase in postpartum maternal mortality, with the most significant rise among Hispanic individuals, underscoring the urgency of addressing these knowledge gaps.

To tackle these challenges, researchers recommend targeted communication strategies, including partnerships with community-based organizations and federally qualified health centers, to effectively disseminate information about Medicaid coverage. However, these initiatives may encounter obstacles due to persistent anti-immigrant sentiment in the U.S. and fears within immigrant communities regarding accessing available benefits.

The implications of this study extend beyond New York City. Out of the 47 states that extended postpartum Medicaid coverage, New York and 11 others provide benefits regardless of immigration status. The findings indicate that these states are witnessing significant improvements in postpartum insurance coverage, while states that exclude certain immigrant groups may not experience similar advancements.

Co-authors of the study include researchers from the New York City Department of Health and Mental Hygiene and various academic institutions who contributed to this important analysis of immigrant health equity.