Women In The United States Experience High Rates Of Coverage ‘Churn’ In Months Before And After Childbirth

Abstract

Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility.

Maternal risk factor index and cesarean delivery among women with nulliparous, term, singleton, vertex deliveries, Texas, 2015

“…32,33 In addition, access to postpartum care beyond the 6 weeks postdelivery would allow women to continue treatment of chronic, behavioral, and pregnancy-induced conditions and have access to family planning services, including counseling on an adequate spacing between pregnancies that can improve subsequent birth outcomes. 34,35 One important limitation of our study was that being a cross-sectional analysis, we could not determine the attributable risk of each maternal risk factor to delivery route. Furthermore, all the maternal risk factors examined were assumed to be of equal importance in terms of their contribution to delivery route.…”

“…To ensure that women begin pregnancy as healthy as possible, it is important to identify and treat chronic conditions and behavioral health problems during the preconception period . In addition, access to postpartum care beyond the 6 weeks postdelivery would allow women to continue treatment of chronic, behavioral, and pregnancy‐induced conditions and have access to family planning services, including counseling on an adequate spacing between pregnancies that can improve subsequent birth outcomes …”

Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005–2014

“…22 High insurance coverage rates at delivery, as found in this study, mask the high rates of the often low-income women who are uninsured before or after their pregnancies, as categorical Medicaid coverage ends 60 days postpartum. 23 Futhermore, insurance coverage for pregnancy care and delivery does not necessarily mean that benefits include chronic disease management. For instance, variation exists in insurance coverage of evidence-based medication-assisted-treatment for substance use disorders.…”

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

“…23,38 In addition, access to postpartum care beyond six weeks postdelivery, and optimizing health during the interpregnancy period would allow women to continue treatment of these conditions and improve overall health. [39][40][41] It should also be noted that the mere presence of these chronic conditions along with the different combinations of comorbid conditions influences the clinical management of pregnancy and labor. 7,42 Thus, optimizing preconception health does not only reduce comorbid conditions but also reduce the likelihood of having medically unnecessary cesarean birth and its consequent adversities.…”