Analysis of Contraceptive Use Among Immigrant Women Following Expansion of Medicaid Coverage for Postpartum Care

Rodríguez, María I.; Skye, Megan; Lindner, Stephan; Caughey, Aaron B.; Lòpez-DeFede, Ana; Darney, Blair G.; McConnell, K. John

doi:10.1001/jamanetworkopen.2021.38983

Cited by 9 publications

(19 citation statements)

References 30 publications

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“…For the full report, our electronic searches yielded 25 973 citations (Figure). We screened 589 full-text articles, of which 28 studies, reported in 29 articles, were eligible for the current systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, 2 studies evaluated the impact of policy changes that made insurance coverage less comprehensive: 1 study in North Carolina that evaluated a policy reducing reimbursement rates for maternity care coordination by 19% and 1 study in Oregon that evaluated a policy requiring undocumented immigrants and legal immigrants within 5 years of immigration with Emergency Medicaid who wanted sterilization following vaginal delivery to pay for it . Finally, 9 studies compared outcomes in various insurance expansion and nonexpansion (or contraction) states …”

Section: Resultsmentioning

confidence: 99%

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Health Insurance Coverage and Postpartum Outcomes in the US

Saldanha,

Adam,

Kanaan

et al. 2023

JAMA Netw Open

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ImportanceApproximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care.ObjectiveTo assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum.Evidence ReviewMedline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide.FindingsA total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits.Conclusions and RelevanceThe findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Health Insurance Coverage and Postpartum Outcomes in the US

Saldanha,

Adam,

Kanaan

et al. 2023

JAMA Netw Open

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“…Births were identified using International Classification of Disease, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes as well as Current Procedural Terminology codes and using a previously published algorithm. 17 , 18 , 19 …”

Section: Methodsmentioning

confidence: 99%

“…We examined the use of any antidiabetic agent among pregnant patients with diabetes and the use of insulin alone, which is the first-line pharmacotherapy recommended for glycemic optimization during pregnancy. Births were identified using International Classification of Disease, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes as well as Current Procedural Terminology codes and using a previously published algorithm …”

Section: Methodsmentioning

confidence: 99%

“…We examined the use of any antidiabetic agent among pregnant patients with diabetes and the use of insulin alone, which is the first-line Terminology codes and using a previously published algorithm. [17][18][19] Our secondary health outcomes included measures of maternal and newborn health. We examined the association of prenatal care expansion with gestational hypertension, cesarean birth, and postpartum contraception.…”

Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 99%

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Association of Prenatal Care Expansion With Use of Antidiabetic Agents During Pregnancies Among Latina Emergency Medicaid Recipients With Gestational Diabetes

et al. 2022

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Key Points Question Is there an association between prenatal care coverage in emergency Medicaid (a program of restricted Medicaid services for recent immigrants with low income who are pregnant) and the use of antidiabetic agents by pregnant Latina individuals with gestational diabetes? Findings This cohort study of 4869 Latina patients with gestational (n = 2907) or preexisting diabetes (n = 1962) found that when Medicaid expanded coverage to include prenatal care for individuals enrolled in emergency Medicaid, receipt of antidiabetic agents and postpartum contraception significantly increased. However, there was no significant association of this prenatal care expansion with cesarean births, preterm birth, large size for gestational age, or neonatal intensive care unit admission. Meaning This study suggests that expansion of prenatal care coverage, without postpartum care or ongoing coverage, was associated with increased use of antidiabetic agents during pregnancy.

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State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

Steenland,

Fabi,

Bellerose

et al. 2023

JAMA

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ImportanceProfessional medical organizations recommend that adults receive routine postpartum care. Yet, some states restrict public insurance coverage for undocumented immigrants and recently documented immigrants (those who received legal documentation status within the past 5 years).ObjectiveTo examine the association between public insurance coverage and postpartum care among low-income immigrants and the difference in receipt of postpartum care among immigrants relative to nonimmigrants.Design, Setting, and ParticipantsA pooled, cross-sectional analysis was conducted using data from the Pregnancy Risk Assessment Monitoring System for 19 states and New York City including low-income adults with a live birth between 2012 and 2019.ExposureGiving birth in a state that offered public insurance coverage for postpartum care to recently documented or undocumented immigrants.Main Outcomes and MeasuresSelf-reported receipt of postpartum care by the category of coverage offered (full coverage: states that offered publicly funded postpartum care regardless of immigration status; moderate coverage: states that offered publicly funded postpartum care to lawfully residing immigrants without a 5-year waiting period, but did not offer postpartum care to undocumented immigrants; no coverage: states that did not offer publicly funded postpartum care to lawfully present immigrants before 5 years of legal residence or to undocumented immigrants).ResultsThe study included 72 981 low-income adults (20 971 immigrants [29%] and 52 010 nonimmigrants [71%]). Of the 19 included states and New York City, 6 offered full coverage, 9 offered moderate coverage, and 4 offered no coverage; 1 state (Oregon) switched from offering moderate coverage to offering full coverage. Compared with the states that offered full coverage, receipt of postpartum care among immigrants was 7.0–percentage-points lower (95% CI, −10.6 to −3.4 percentage points) in the states that offered moderate coverage and 11.3–percentage-points lower (95% CI, −13.9 to −8.8 percentage points) in the states that offered no coverage. The differences in the receipt of postpartum care among immigrants relative to nonimmigrants were also associated with the coverage categories. Compared with the states that offered full coverage, there was a 3.3–percentage-point larger difference (95% CI, −5.3 to −1.4 percentage points) in the states that offered moderate coverage and a 7.7–percentage-point larger difference (95% CI, −10.3 to −5.0 percentage points) in the states that offered no coverage.Conclusions and RelevanceCompared with states without insurance restrictions, immigrants living in states with public insurance restrictions were less likely to receive postpartum care. Restricting public insurance coverage may be an important policy-driven barrier to receipt of recommended pregnancy care and improved maternal health among immigrants.

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Analysis of Contraceptive Use Among Immigrant Women Following Expansion of Medicaid Coverage for Postpartum Care

Cited by 9 publications

References 30 publications

Health Insurance Coverage and Postpartum Outcomes in the US

Health Insurance Coverage and Postpartum Outcomes in the US

Association of Prenatal Care Expansion With Use of Antidiabetic Agents During Pregnancies Among Latina Emergency Medicaid Recipients With Gestational Diabetes

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

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