The ACA Medicaid expansion increased insurance coverage for low-income women of reproductive age, with the greatest effects for women without dependent children and women residing in states with relatively lower pre-ACA Medicaid eligibility levels or with no family planning waiver before the ACA.

The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups. Improved outcomes were achieved at lower costs. There were few improvements in outcomes for participants who received group prenatal care, although their costs were lower in the prenatal period, and no improvements in outcomes for participants in maternity care homes.

Medicaid has a long history of serving pregnant women, but many women are not eligible for Medicaid before pregnancy or after sixty days postpartum. We used data for new mothers with Medicaid-covered prenatal care in 2015-18 from forty-three states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) to describe patterns of perinatal uninsurance and health outcomes of women experiencing uninsurance. We found that 26.8 percent of new mothers with Medicaid-covered prenatal care were uninsured before pregnancy, 21.9 percent became uninsured two to six months postpartum, and 34.5 percent were uninsured in either period, with higher perinatal uninsurance rates in nonexpansion states and for Hispanic women who completed the PRAMS survey in Spanish. Together, our findings indicate that despite recent coverage gains, further policy change is needed to help women maintain health insurance coverage before and after pregnancy and to allow them to address ongoing health issues including obesity and depression.

BACKGROUND: Medicaid plays a critical role during the perinatal period, but pregnancy-related Medicaid eligibility only extends for 60 days post partum. In 2014, the Affordable Care Act's (ACA's) Medicaid expansions increased adult Medicaid eligibility to 138% of the federal poverty level in participating states, allowing eligible new mothers to remain covered after pregnancy-related coverage expires. We investigate the impact of ACA Medicaid expansions on insurance coverage among new mothers living in poverty. METHODS:We define new mothers living in poverty as women ages 19 to 44 with incomes below the federal poverty level who report giving birth in the past 12 months. We use 2010-2017 American Community Survey data and a difference-in-differences approach using parental Medicaid-eligibility thresholds to estimate the effect of ACA Medicaid expansions on insurance coverage among poor new mothers.RESULTS: A 100-percentage-point increase in parental Medicaid-eligibility is associated with an 8.8-percentage-point decrease (P , .001) in uninsurance, a 13.2-percentage-point increase (P , .001) in Medicaid coverage, and a 4.4-percentage-point decrease in private or other coverage (P = .001) among poor new mothers. The average increase in Medicaid eligibility is associated with a 28% decrease in uninsurance, a 13% increase in Medicaid coverage, and an 18% decline in private or other insurance among poor new mothers in expansion states. However, in 2017, there were ∼142 000 remaining uninsured, poor new mothers.CONCLUSIONS: ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers. Opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.WHAT'S KNOWN ON THIS SUBJECT: Affordable Care Act Medicaid expansions increased health insurance coverage and access to and affordability of care for adults, parents, and women of reproductive age. Parental insurance coverage has spillover benefits for children, including reduced uninsurance and improved family financial security.WHAT THIS STUDY ADDS: Affordable Care Act Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among new mothers living in poverty. However, thousands of new mothers in the United States remained uninsured in 2017, and opportunities remain to increase coverage.

This study used bivariate and regression-adjusted analyses of participant-level survey and medical data to investigate prevalence of depression among pregnant Medicaid participants, correlates of depression, and the relationship between depression and pregnancy outcomes. The sample included Medicaid participants with a single gestation and valid depression data who were enrolled in Strong Start for Mothers and Newborns 2, a national preterm birth prevention program, from 2013 to 2017 (N = 37,287; 85% of total enrollment). Depression rates in Strong Start were high (27.5%). Depression was associated with being black; having other children, an unplanned pregnancy, or challenges accessing prenatal care; not having a co-resident spouse or partner; and experiencing intimate partner violence. After these and other risk factors were controlled for, depression remained associated with higher rates of preterm birth. Systematic screening and holistic approaches to prenatal care that address depression and associated risks could help reduce rates of preterm birth and other poor pregnancy outcomes.