A federal policy requiring states to keep Medicaid recipients enrolled during the COVID-19 pandemic expanded postpartum Medicaid coverage across the country, leading to a surge in the number of people remaining insured after giving birth, according to Rutgers Health researchers.
Analysis published in of Milbank Quarterly Magazine, A study of Medicaid claims in 15 states found that this coverage expansion resulted in modest changes in health care utilization, with significant increases in emergency department visits and mental and behavioral health examinations.
Medicaid claims data provides important insights into service utilization and maternal health status. However, because we typically rely on insurance claims data to show what medical expenses were billed, we do not necessarily know whether individuals understood that they remained covered or what barriers they faced in seeking care. ”
Erika Eliason, assistant professor at Rutgers Health Policy Center and Rutgers School of Public Health and lead author of the analysis
The Continuing Coverage Requirement of the Families First Coronavirus Response Act provided enhanced federal funding to states in exchange for a moratorium on disenrollment and increased coverage continuity for individuals after birth.
The study of approximately 489,000 postpartum individuals examined how the law’s expanded eligibility affected Medicaid enrollment, coverage retention, and use of Medicaid fee-for-service care from three to 12 months after childbirth, a period previously not covered for pregnant Medicaid recipients.
It compared postpartum Medicaid outcomes during the pandemic-era period of continued coverage with outcomes a year earlier.
The percentage of people who maintain Medicaid coverage 12 months after giving birth increased from 37% before the Families First Coronavirus Response Act to 77%.
During the 3- to 12-month postpartum period, when Medicaid typically ends during pregnancy, the extension of eligibility led to an increase in Medicaid emergency department visits and an increase in the proportion of people receiving services with mental or behavioral health assessments.
However, this analysis did not identify an increase in outpatient visits or pregnancy-related diagnoses during the extended coverage period. For example, the eligibility extension increased emergency department use by approximately 107 visits per 1,000 beneficiaries, but there was no statistically significant change in outpatient visits.
Eliason said it is difficult to determine whether beneficiaries sought care outside of Medicaid, whether a sense of continuity of coverage influenced care seeking, and how pandemic-related service disruptions affected overall care utilization.
The authors of the analysis emphasized the importance of taking a patient-centered approach to expanding postnatal coverage. They said the 49 states that have implemented 12-month postpartum coverage should pair this extension with communication and advocacy strategies to help individuals recognize and take advantage of postpartum Medicaid coverage.
“I would like to advise policymakers that continuous postpartum coverage is an important tool for states to monitor and improve the health outcomes of people and their babies after birth,” Eliason said. “However, without strong communication and support, expanding eligibility may not fully translate into improved access and outcomes.”
The study’s authors, based at Rutgers University and the University of Maryland, called for future studies to examine postpartum security and health outcomes in additional populations over longer periods of time under stable public health conditions.
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Reference magazines:
Eliasson, E.L. others. (2026). Extending Medicaid and Postpartum Enrollment and Health Care Access During Pregnancy During COVID-19. Milbank Quarterly Magazine. DOI: 10.1111/1468-0009.70079. https://onlinelibrary.wiley.com/doi/10.1111/1468-0009.70079
