Postpartum Care Utilization, Spending Among Beneficiaries With Medicaid vs Commercial Insurance

Compared to continuous Medicaid coverage, continuous commercial coverage after a Medicaid-paid birth was associated with greater use of primary care, fewer emergency department visits, and higher spending. Researchers published their findings in JAMA Network Open.

“Approximately 20% of individuals with Medicaid-paid births subsequently enroll in commercial coverage, indicating that postpartum Medicaid extensions could result in a shift from commercial coverage to Medicaid during months 3-12 postpartum,” wrote Sarah H Gordon, PhD, Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, and coauthors.

“Evidence is needed to understand the implications of potentially shifting individuals from commercial to Medicaid coverage during the postpartum year under proposed extensions of postpartum Medicaid coverage.”

Authors conducted the cross-sectional study using the Colorado All Payer Claims Database. Analysis included all-payer claims, birth records, and income data for individuals who had a Medicaid-paid birth between 2014-2019.

The final sample included 44,471 people aged 26.8 years on average. There were 42,989 people with continuous Medicaid coverage and 1482 people with continuous commercial coverage.

Self-reported demographic data indicated 2.9% (1279) of individuals were Asian, 9.1% (4028) were Black, 75.4% (33,534) were White, and 12.7% (5630) were of another race and ethnicity. Additionally, 43.5% (19,337) of individuals in the sample were Hispanic.

From 3-12 months postpartum, those with commercial insurance were more likely to receive primary care [2.46 percentage points (95% CI, 2.12-2.79 percentage points; P<.001)] and had .81 more primary care visits total (95% CI, .70-.92; P<.001) compared to individuals with Medicaid. Those with commercial coverage were also less likely to use the emergency department by comparison [7.92 percentage points (95% CI, -8.44 to -7.4 percentage points; P=.006).

“These findings could reflect higher barriers to [emergency department] care in commercial insurance or better access to preventive care in commercial plans,” Gordon and coauthors noted. “Rates of [emergency department] use were high in both the Medicaid and commercial insurance groups, suggesting that this is a common source of care for the postpartum population.”

Greater spending was also associated with continuous commercial insurance. Total adjusted per person spending and total out-of-pocket spending per person were $1110 (95% CI, $509-$1710; P<.001) and $796 (95% CI, $754-$838; P<.001) higher, respectively, compared to spending under Medicaid.

“Differences in total spending likely reflect lower prices for medical services paid by Medicaid compared with commercial insurance plans,” authors wrote. “Overall, we found that per capita Medicaid spending for the postpartum sample during months 3-12 postpartum was approximately $4200, less than per capita annual spending for the Medicaid expansion sample, for which the median was $6673 across 17 states in 2018.”

Extended Medicaid coverage in the postpartum year under the American Rescue Plan has the potential to reduce total and out-of-pocket spending, authors concluded.

Reference:
Gordon SH, Hoagland A, Admon LK. Comparison of postpartum health care use and spending among individuals with Medicaid-paid births enrolled in continuous Medicaid vs commercial insurance. JAMA Netw Open. 2022;5(3):e223058. doi:10.1001/jamanetworkopen.2022.3058