A recent study reveals the significant impact of Medicaid coverage policies on maternal health disparities, particularly for low-income immigrants in the United States. The study shows that restrictive public insurance eligibility policies can hinder access to postpartum care, affecting both immigrant and non-immigrant mothers. Lack of postpartum care has serious consequences, and the findings underscore the need for more inclusive health policies to address maternal health disparities and improve access to care, especially for vulnerable populations.
A recent study sheds light on how Medicaid coverage policies influence disparities in maternal health. Medicaid plays a crucial role in providing maternal and postpartum care for low-income individuals in the United States, covering approximately 42% of all births. Maternity care is extended to at least two months after delivery, with variations depending on state and local policies.
However, immigrants often lack access to this coverage, rendering them more susceptible to maternal health issues, as revealed in a comprehensive study that examined nearly 73,000 postpartum individuals across 19 states and New York City from 2012 to 2019. Published in the Journal of the American Medical Association, this study quantifies the impact of restrictive public insurance eligibility policies for immigrants on maternal care for low-income individuals. This study is noteworthy for two main reasons: it offers new data regarding postpartum coverage for immigrants and demonstrates that restrictive policies reduce access to maternity care for all low-income immigrants, regardless of their documentation status, as well as for non-immigrants.
In the United States, nearly half of low-income, noncitizen immigrant women of reproductive age lack health insurance, compared to only 16% of low-income U.S. citizen women aged 15 to 44. Medicaid coverage for pregnancy is accessible to immigrants who meet specific income thresholds, typically below 207% of the poverty line, but only after being documented for a minimum of five years. This leaves out both undocumented immigrants and recent immigrants who are pregnant from traditional Medicaid coverage.
Approximately half of U.S. states bridge this Medicaid gap by covering postpartum care for all documented immigrants, eliminating the five-year waiting period. Additionally, 20 states offer some form of public insurance for all income-eligible pregnancies, regardless of immigration status, although only a few of them extend coverage into the postpartum period. Consequently, even when pregnancy is covered by public health insurance, low-income immigrant mothers often lose eligibility shortly after giving birth and may miss the initial follow-up visit that is typically scheduled within one to three months after delivery. This period is critical for new mothers since 65% of maternal deaths in the U.S. occur within the first year postpartum.
The study in JAMA aimed to measure the impact of eligibility options on the accessibility of postpartum care for low-income immigrant mothers. The states were divided into three groups for analysis: “no coverage” states that provided health coverage solely to immigrants documented for at least five years, “moderate coverage” states that covered all documented immigrants (excluding undocumented ones) before the five-year waiting period, and “full coverage” states that covered all immigrants, regardless of status.
To evaluate the impact of these policies, the study used data from the states’ Pregnancy Risk Assessment Monitoring System (PRAMS), which collects information on maternal health. The research compared responses between non-immigrant and immigrant mothers, as well as between immigrant mothers in states with different levels of coverage. Maria Steenland, an assistant professor at Brown University’s Population Studies and Training Center and one of the study’s lead authors, noted, “Compared to immigrants living in states where there were no restrictions based on immigration status on who could be offered public postpartum care, immigrants living in states with restricted public insurance coverage policies were less likely to receive postpartum care.”
In states with no coverage for recently documented and undocumented immigrants, 20% of low-income postpartum immigrants did not receive any care, compared to 12% of low-income postpartum non-immigrants. However, in states offering access to all immigrants, the situation reversed, with more low-income immigrants accessing postpartum care (89.5%) than non-immigrants (87.7%).
The study also indicates that the absence of coverage for immigrant parents affects the maternal care coverage for non-immigrants. In “no coverage” states, access to postpartum services was 4% lower for non-immigrants compared to “full coverage” states.
This suggests that these states face additional challenges that affect low-income individuals, as noted by Laura Wherry, a study co-author and assistant professor at New York University’s Wagner Graduate School of Public Service.
Inadequate postpartum care can have serious consequences, including early breastfeeding discontinuation, undiagnosed postpartum depression and anxiety disorders, lack of family planning, and an increased risk of preterm birth, preeclampsia, and gestational diabetes, as stated by Haywood Brown, a professor of obstetrics and gynecology at the University of South Florida. Furthermore, insufficient postpartum care contributes to racial and ethnic disparities in maternal health, according to the Medicaid and CHIP Payment and Access Commission (MACPAC). Since a majority of low-income immigrants in the U.S. are Hispanic, insurance policy restrictions disproportionately impact this demographic.
The study’s findings suggest that restrictive policies worsen disparities between U.S.-born mothers and those giving birth in the country and highlight the potential for policy improvements to enhance maternal health.
As states reconsider their Medicaid eligibility requirements, this research takes on particular significance, emphasized Cheasty Anderson, deputy director of the Protecting Immigrant Families Coalition. She stated, “The JAMA study reinforces what we hear from organizations all over the country — immigrant-inclusive health policies are critical to meeting health care needs. Restrictive policies are a threat to the nation’s health and, as postpartum care illustrates, have consequences for the U.S. citizen children and spouses of immigrants as well.”
