Immigrant Inequities in Uninsurance and Postpartum Medicaid Extension: A Quasi-Experimental Study in New York City, 2016-2021.

Objectives. To determine if de facto postpartum Medicaid extension during the Families First Coronavirus Response Act (FFCRA) reduced immigrant versus US-born inequities in uninsurance. Methods. We assessed self-reported uninsurance at 2 to 6 months postpartum among people with Medicaid-paid births using the New York City Pregnancy Risk Assessment Monitoring System (PRAMS), comparing immigrant and US-born people. We created a pre-FFCRA cohort of 2611 births from 2016 to 2019 and a post-FFCRA implementation cohort of 1197 births from 2020 to 2021. We calculated risk differences using log binomial regression. Results. Self-reported postpartum uninsurance among immigrants decreased from 13.6% to 9.3% after FFCRA (adjusted risk difference = -4.9%; 95% confidence interval = -7.8%, -2.0%). Immigrant versus US-born inequities in postpartum uninsurance decreased except among Hispanic birthing people, among whom 1 in 6 reported they were uninsured during FFCRA, despite continued eligibility. Conclusions. De facto postpartum Medicaid extension decreased immigrant inequities in insurance coverage, but Hispanic immigrants may have been unaware of continued coverage. Public Health Implications. Postpartum Medicaid extension policies that are inclusive of all immigrants may decrease inequities, but community-integrated implementation is needed to raise awareness of coverage and advance postpartum maternal health equity. (Am J Public Health. Published online ahead of print February 27, 2025:e1-e4. https://doi.org/10.2105/AJPH.2024.307968).