A study from Columbia University Mailman School of Public Health released on Mar. 17 found that continuous Medicaid coverage during the COVID-19 pandemic reduced postpartum uninsurance among Black women in states that did not expand Medicaid, but racial disparities in insurance coverage persisted. The research, published in the American Journal of Preventive Medicine, is the first to examine how this policy affected racial equity in postpartum insurance while considering states' Medicaid expansion status under the Affordable Care Act.
The findings are significant because extending Medicaid coverage to 12 months after childbirth is seen as a key strategy for reducing maternal morbidity and mortality, especially in non-expansion states. The federal continuous Medicaid coverage provision enacted at the start of the pandemic provided an opportunity to evaluate how such policies impact postpartum insurance rates.
"Postpartum is a crucial time for preventing postpartum morbidity and mortality. The postpartum period is one of intense physiologic and psychosocial adaptation and requires consistent monitoring of health to support women during this critical time," said Teresa Janevic, PhD, associate professor of Epidemiology at Columbia Mailman School. "Our goal was to examine changes in postpartum uninsurance, Medicaid coverage, and private insurance before and during the continuous coverage provision among Black and White women, and to understand how those changes differed in Medicaid expansion and non-expansion states."
The study noted that Black women had twice the rate of pregnancy-related death within 42 days of delivery compared with non-Hispanic White women in 2022, and were more than four times as likely to die from pregnancy-associated causes up to 12 months after birth. Prior to the pandemic, uninsurance rates for Black women were significantly higher in non-expansion states—16.5 percent compared with 6.4 percent in expansion states.
Researchers analyzed data from the American Community Survey between 2016–2019 and 2021–2023 across all U.S. states and Washington D.C., including over 157,000 non-Hispanic Black and White women who had given birth within the previous year. They adjusted their analysis for age, employment status, and household income.
Janevic said that while extending Medicaid postpartum coverage can reduce overall uninsurance rates—especially where Medicaid has not been expanded—the policy alone may not be enough to close racial gaps: "While racial inequities in insurance coverage persisted, our findings suggest that postpartum Medicaid extension plays an important role in improving access to postpartum care," she said. "At the same time, it is unlikely to be sufficient on its own to address the U.S. Black maternal health crisis."
