Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits

Abstract Background The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for child birth. No prenatal or postpartum care is covered. The majority of women enrolled in Emergency Medicaid are Latina. Objective We assessed postpartum visits and receipt of postpartum contraception, comparing outcomes for Emergency (restricted benefit) Medicaid to Traditional (full-benefit) Medicaid in Oregon and South Carolina, two states with similar sized immigrant populations. Methods We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency Medicaid) between January 1, 2010, and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (Immediate postpartum [IPP], within one month, one to two months, and two to six months) by type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs. Emergency) and postpartum visit attendance and contraception were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort, and conducted a sub-analysis restricted to only Latina women. Results Our study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age > 35; 18.1% vs 7.2% p Latinas with births covered by Emergency Medicaid had a 1.9% (95% CI: 1.8 – 2.0%) adjusted probability of postpartum contraception use within two months, compared to 39.8% (95% CI: 38.7 – 39.9 %) among Latinas enrolled in Traditional Medicaid. Conclusion Women enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children.