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Promoting continuous coverage during the postpartum period: lessons learned from Medicaid coverage transitions and the public health emergency
Promoting continuous coverage during the postpartum period: lessons learned from Medicaid coverage transitions and the public health emergency
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Urban Institute research report
- Author(s):
- Johnston, Emily M., author
Haley, Jennifer M., author
Thomas, Tyler W., author - Contributor(s):
- Urban Institute, issuing body.
- Publication:
- Washington, DC : Urban Institute, September 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Maternal Mortality
Medicaid -- organization & administration
Medically Uninsured -- legislation & jurisprudence
Postpartum Period
United States
Children's Health Insurance Program (U.S.) - Genre(s):
- Technical Report
- Abstract:
- Compared with other adults, pregnant people can access Medicaid/Children’s Health Insurance Program (CHIP) coverage at much higher income levels in most states, ranging from 138 to 380 percent of the federal poverty level (FPL). In nearly every state, pregnancy-related coverage has been broadly defined to include comprehensive health benefits, including postpartum care and care unrelated to pregnancy, and has minimal cost sharing (Haley et al. 2021). But pregnancy-related Medicaid/CHIP coverage expires 60 days after pregnancy ends, at which point states must assess a person’s eligibility for other Medicaid eligibility pathways or other insurance affordability programs, like the Marketplace (CMS 2021). If postpartum people are eligible for another Medicaid pathway, they should transition to that coverage to avoid having their Medicaid coverage terminated. But little research or data indicate how states redetermine eligibility to identify those eligible under another pathway, so it is unclear how successful these coverage transitions are. Those losing pregnancy-related coverage are most likely to qualify for Medicaid through adult or parent pathways. But, as noted, the income eligibility thresholds for these pathways are typically much lower than those for pregnancy-related coverage. The median eligibility threshold for adults is 138 percent of FPL in states that have adopted Medicaid expansion under the Affordable Care Act (hereafter called “expansion states”), but it is below 50 percent of FPL in states that have not expanded Medicaid (hereafter called “nonexpansion states”; Brooks et al. 2020). People with incomes above their state’s adult or parental Medicaid thresholds may be eligible solely for Medicaid family planning benefits, if offered in their state, which are limited to specific reproductive health services. Outside Medicaid, publicly subsidized coverage is available through the Affordable Care Act’s Marketplaces for people with incomes between 100 and 400 percent of FPL who do not have an affordable employer-sponsored insurance offer. However, outside of the temporary increase in subsidies recently enacted in the American Rescue Plan (Rae et al. 2021), this coverage can require considerable cost sharing and applicants may face enrollment hurdles. Moreover, new parents in nonexpansion states with incomes below the FPL are in the “coverage gap,” meaning their incomes are too high to qualify for Medicaid at their states’ very low eligibility thresholds but too low to qualify for subsidized Marketplace coverage. Therefore, though some may qualify for limited family planning benefits, they are ineligible for comprehensive publicly subsidized coverage. These people may enroll in employer coverage if it is available to them and affordable. Otherwise, they will likely become uninsured when their pregnancy-related Medicaid coverage is terminated 60 days postpartum. Because of these eligibility rules, about 1 in 4 of the 440,000 women estimated to be uninsured in the first year postpartum annually appeared to be eligible for Medicaid but not enrolled in 2016 through 2018 (Johnston, Haley, et al. 2021). This suggests many people who have Medicaid/CHIP coverage for prenatal care and delivery are not being appropriately transitioned to other coverage for which they qualify when their pregnancy-related coverage ends.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (x, 29 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918299887406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918299887406676