Extending Postpartum Medicaid Linked to Increased Perinatal Mental Health Care

Sarah H. Gordon, PhD

Credit: Boston University School of Public Health

Extending pregnancy-related Medicaid eligibility from 60 days to 12 months is linked to a 20.5-percentage-point increase in prescription medication or outpatient mental health treatment for perinatal mood and anxiety disorders. The data suggests the extension helps mothers in a low-income postpartum population.

Approximately 1 in 7 births in the US have mothers with perinatal mood and anxiety disorders, and these mental health disorders are the leading cause of perinatal morbidity and mortality. Perinatal mood and anxiety disorders are linked to a greater risk of suicide, substance abuse, and long-term depression and anxiety. This can also affect the infants, as newborns of mothers with perinatal depression and depression experience lower rates of breastfeeding and developmental delays.

Perinatal mood and anxiety disorders can also be costly since mothers may have declined economic productivity and many health payments. The estimated 5-year cost of untreated perinatal mood disorders is $31,800 per mother.

“Evidence-based treatments are available and effective, but underutilized,” said lead investigator Sarah H. Gordon, PhD, assistant professor of health law, policy & management at Boston University School of Public Health, in a press release.2 “Insufficient health insurance coverage is one reason for low treatment rates among the postpartum population that extending postpartum Medicaid coverage can address.”

In 2021, the American Rescue Plan Act allowed states to opt in receiving federal matching funds to extend postpartum Medicaid eligibility from 60 days to 12 months. By February 2024, 44 states and Washington DC had implemented the extensions. However, despite the act, not much was known about the effects of the postpartum Medicaid extension and how it impacted a new mother’s access to mental health care.

Investigators conducted a study with a “fuzzy” regression discontinuity design to investigate whether extending Medicaid eligibility from 60 days to 12 months would increase the use of mental health care among low-income postpartum individuals. Leveraging linked data from Colorado All Payer Claims Database, birth records (obtained from the Colorado Department of Public Health and Environment), and individual-level income data (Colorado Department of Health Care Policy and Financing) during 2014 – 2019, the team compared rates of postpartum mental health treatment for perinatal mood and anxiety disorders who lay on the poverty line at or below 138 percent (eligible to keep Medicaid) and above 138 percent (ineligible for Medicaid after 60 days postpartum).

For people in Colorado, the Medicaid eligibility for pregnant women was 265 percent of the poverty level. However, after 60 days, new mothers had to sit at 138 percent of poverty to stay eligible for Medicaid.

The sample included 115,244 Medicaid-insured people in Colorado, with 86.9% having incomes at or below 138 percent of poverty. About 3 quarters of the participants were White, followed by other races (11.7%), Black (10%), and Asian (3.5%).

Participants at or below 138 percent of poverty were more likely to seek postpartum mental health treatment than participants above 138 percent of poverty. However, people at 138 percent of poverty were more likely to discontinue treatment.

Gordon and colleagues found extending Medicaid to 12 months was linked to a 20.5-percentage point increase in any use of prescription medication or outpatient mental health treatment (P < .001), a 16.0-percentage-point increase in any use of prescription medication only (P < .001), and a 7.3-percentage-point increase in any use of outpatient mental health treatment only (P = .001). Furthermore, postpartum Medicaid extension was linked to a 19.7-percentage-point increase in continuing to seek mental health care, defined as ≥ 3 outpatient mental health visits or prescription medication fills (P < .001).

Compared with switching to commercial insurance, a postpartum Medicaid extension was associated with a $40.84 lower out-of-pocket cost per outpatient mental health visit (P < .001) and a $3.24 lower cost (P < .001) per prescription for anxiety or depression.

Investigators wrote the study was limited by the inability to generalize the results to a larger population due to only using data from 1 state and only assessing an insured population. Other highlighted limitations included not assessing potential confounders like delivery outcomes, family conflict, and several others. Additionally, the team could not rule out if women had other insurance during the postpartum year.

In July 2022, Colorado extended Medicaid eligibility from 60 days to 12 months postpartum for all pregnant women enrolled in Medicaid.

“Our findings suggest that postpartum Medicaid extensions are likely an important policy lever to promote postpartum maternal mental health by lowering barriers to accessing treatment,” Gordon said. “However, mental health screening and referrals, availability of providers, and quality of mental healthcare are also critical to supporting the mental health of postpartum people.”

^References

1. ^{Gordon SH, Lee S, Steenland MW, Deen N, Feinberg E. Extended Postpartum Medicaid In Colorado Associated With Increased Treatment For Perinatal Mood And Anxiety Disorders. Health Aff (Millwood). 2024;43(4):523-531. doi:10.1377/hlthaff.2023.01441}
2. ^{Extending Medicaid Coverage After Birth May Increase Postpartum Treatment for Depression, Anxiety. EurekAlert! April 3, 2024. https://www.eurekalert.org/news-releases/1040042. Accessed April 11, 2024.}