Association of Medicaid Expansion Under the Affordable Care Act With Medicaid Coverage in the Prepregnancy, Prenatal, and Postpartum Periods

IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Womens Health Issues Pub Date : 2023-11-01 DOI:10.1016/j.whi.2023.08.002
Jiajia Chen PhD , Lijing Ouyang PhD , David A. Goodman PhD , Ekwutosi M. Okoroh MD , Lisa Romero DrPH, MPH , Jean Y. Ko PhD , Shanna Cox MSPH
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Abstract

Introduction

We evaluated how the Affordable Care Act (ACA) Medicaid eligibility expansion affected perinatal insurance coverage patterns for Medicaid-enrolled beneficiaries who gave birth overall and by race/ethnicity. We also examined state-level heterogeneous impacts.

Methods

Using the 2011–2013 Medicaid Analytic eXtract and the 2016–2018 Transformed Medicaid Statistical Information System Analytic File databases, we identified 1.4 million beneficiaries giving birth in 2012 (pre-ACA expansion cohort) and 1.5 million in 2017 (post-ACA expansion cohort). We constructed monthly coverage rates for the two cohorts by state Medicaid expansion status and obtained difference-in-differences estimates of the association of Medicaid expansion with coverage overall and by race/ethnicity group (non-Hispanic White, non-Hispanic Black, and Hispanic). To explore state-level heterogeneous impacts, we divided the expansion and non-expansion states into groups based on the differences in the income eligibility limits for low-income parents in each state between 2012 and 2017.

Results

Medicaid expansion was associated with 13 percentage points higher coverage in the 9 to 12 months before giving birth, and 11 percentage points higher coverage at 6 to 12 months postpartum. Hispanic birthing individuals had the greatest relative increases in coverage, followed by non-Hispanic White and non-Hispanic Black individuals. In Medicaid expansion states, those who experienced the greatest increases in income eligibility limits for low-income parents generally saw the greatest increases in coverage. In non-expansion states, there was less heterogeneity between state groupings.

Conclusions

Pregnancy-related Medicaid eligibility did not have major changes in the 2010s. However, states’ adoption of ACA Medicaid expansion after 2012 was associated with increased Medicaid coverage before, during, and after pregnancy. The increases varied by race/ethnicity and across states.

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根据《平价医疗法案》,医疗补助扩大协会在孕前、产前和产后期间提供医疗补助。
引言:我们评估了《平价医疗法案》(ACA)医疗补助资格扩大对总体上和按种族/民族生育的医疗补助登记受益人的围产期保险覆盖模式的影响。我们还研究了州一级的异质性影响。方法:使用2011-2013年医疗补助分析提取和2016-2018年转化医疗补助统计信息系统分析文件数据库,我们确定了2012年(aca扩展前队列)和2017年(aca扩展后队列)分娩的140万受益人。我们根据州医疗补助扩张状况构建了两个队列的每月覆盖率,并获得了医疗补助扩张与总体覆盖率和种族/族裔群体(非西班牙裔白人、非西班牙裔黑人和西班牙裔)之间的差异估计。为了探讨州一级的异质性影响,我们根据2012年至2017年每个州低收入父母收入资格限制的差异,将扩张州和非扩张州分为不同的组。结果:医疗补助扩大与分娩前9至12个月的覆盖率提高13个百分点有关,产后6至12个月的覆盖率提高11个百分点。西班牙裔生育个体的覆盖率相对增长最大,其次是非西班牙裔白人和非西班牙裔黑人。在扩大医疗补助计划的州,低收入父母的收入资格限制增加最多的州,其覆盖范围的增长幅度也最大。在非扩张状态中,状态组之间的异质性较小。结论:与妊娠相关的医疗补助资格在2010年代没有重大变化。然而,各州在2012年之后采用ACA医疗补助扩大与怀孕前,怀孕期间和怀孕后医疗补助覆盖范围的增加有关。增幅因种族/民族和各州而异。
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来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
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