Changes in postpartum insurance and care use by disability status during the COVID-19 pandemic.

Background: People with disabilities face unique health needs and barriers to perinatal care. The pandemic may have worsened health care access disparities, while pandemic-era Medicaid provisions potentially improved access via increased insurance coverage.

Objective: We assessed changes in postpartum insurance, visits, and reproductive health care during the COVID-19 public health emergency (PHE) and PHE Medicaid provisions among individuals with disabilities versus individuals without disabilities.

Social Determinants and Perinatal Hardships During the COVID-19 Pandemic.

This study examined perinatal experiences of pandemic-related hardships and disparities by race/ethnicity, income, insurance type at childbirth, and urban/rural residency. We used cross-sectional survey data from the 2020 Pregnancy Risk Assessment Monitoring System COVID-19 supplement in 26 states, the District of Columbia, and New York City to explore: (1) job loss or cut work hours/pay, (2) having to move/relocate or becoming homeless, (3) problems paying the rent, mortgage, or bills, or (4) worries that food would run out. We estimated the prevalence of outcomes overall and by race/ethnicity, income, insurance, and urban/rural residency.

Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic.

Objective: Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type.

Methods: This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations.

Differences in Use of Fertility Treatment Between People With Medicaid and Private Health Insurance Coverage in the United States.

Objectives: We aimed to compare differences in receipt of any and specific types of fertility services between people with Medicaid and private insurance.

Methods: We used National Survey of Family Growth (2002-2019) data and linear probability regression models to examine the association between insurance type (Medicaid or private) and fertility service use. The primary outcome was use of fertility services in the past 12 months, and secondary outcomes were use of specific types of fertility services at any time: 1) testing, 2) common medical treatment, and 3) use of any fertility treatment type (testing, medical treatment, or surgical treatment of infertility).

Perinatal Care Changes During COVID-19: A Population-Based Analysis by Race/Ethnicity.

Introduction: The COVID-19 public health emergency created unprecedented disruptions in the use of healthcare services, which could have affected long-standing racial‒ethnic disparities in maternal care use and outcomes. This study evaluates population-level changes in perinatal health services associated with the COVID-19 pandemic overall and by maternal race‒ethnicity.

Methods: In this analysis of all U.

Changes in Postpartum Insurance Coverage in the US During the COVID-19 Pandemic.

This cross-sectional study examines changes in postpartum insurance churn during the COVID-19 pandemic.

The Association Between Postpartum Insurance Instability and Access to Postpartum Mental Health Services: Evidence From Colorado.

Introduction: The objective of this study was to assess the association between postpartum insurance instability and access to postpartum mental health services.

Methods: We used 2018-2019 Colorado Health eMoms survey data, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified as stably insured or unstably insured based on postpartum insurance status at each time point.

Presumptive eligibility for pregnancy Medicaid and timely prenatal care access.

Objective: To assess the association between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access.

Data Source: 2012-2019 National Center for Health Statistics natality files.

Study Design: We used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education.

Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.

Objectives: Before the Affordable Care Act (ACA), 55% of individuals giving birth with Medicaid lost insurance postpartum, potentially affecting their access to postpartum contraception. We evaluate the association of the ACA Medicaid expansions with postpartum contraceptive use and pregnancy at the time of the survey.

Methods: We used 2012-2019 Pregnancy Risk Assessment Monitoring System data to estimate difference-in-difference models for the association of Medicaid expansions with the use of postpartum contraception (mean: 4 months postpartum): any contraception, long-acting reversible contraception, or LARC (contraceptive implant and intrauterine device), short-acting (contraceptive pill, patch, and ring), permanent, or non-prescription methods (condoms, rhythm method, and withdrawal), and pregnancy at the time of the survey.

Association of Affordable Care Act Medicaid Expansions with Births Among Low-Income Women of Reproductive Age.

This study examined the association between Medicaid expansions under the Affordable Care Act (ACA) and births among low-income women of reproductive age in the United States. We used data from the 2008 to 2019 American Community Survey to estimate the association between state adoption of Medicaid expansion under the ACA and the percent of low-income women of reproductive age with a birth in the past year using a difference-in-difference research design. Subgroup analysis was explored by race and ethnicity, age group, educational attainment, marital status, and number of children.

Mental Health and Postpartum Care in California: Implications from California's Provisional Postpartum Care Extension.

Background: California's Provisional Postpartum Care Extension (PPCE) extended Medicaid eligibility through 1 year postpartum for women enrolled in Medi-Cal with annual household incomes of 138%-322% of the federal poverty level and maternal mental health diagnoses.

Methods: For this cross-sectional descriptive study, we used the 2017 Listening to Mothers in California survey of postpartum women to identify those potentially eligible for PPCE. We then sought to describe their demographic characteristics, self-reported mental health, and utilization of postpartum care and mental health services compared with those with Medi-Cal during pregnancy who did not meet PPCE eligibility criteria.

Understanding the Aggressive Practices of Nonprofit Hospitals in Pursuit of Patient Debt.

Nonprofit hospitals have attracted scrutiny for aggressive collection activities against patients, which persist despite the Patient Protection and Affordable Care Act's attempt to limit particularly egregious practices, called "extraordinary collection actions" (ECAs). This study examines the prevalence of ECAs and characteristics of nonprofit hospitals that reported this behavior as of 2016. Using Community Benefit Insight data, characteristics of hospitals that reported ECAs are compared with hospitals that did not report these practices.

Association of Medicaid vs Marketplace Eligibility on Maternal Coverage and Access With Prenatal and Postpartum Care.

Importance: Policy makers are considering insurance expansions to improve maternal health. The tradeoffs between expanding Medicaid or subsidized private insurance for maternal coverage and care are unknown.

Objective: To compare maternal coverage and care by Medicaid vs marketplace eligibility.

Mortality Disparities Among Sexual Minority Adults in the United States.

This study aimed to investigate mortality disparities for sexual minority adults in the United States. We used data from 26,384 adult respondents using the 1999-2014 National Health and Nutrition Examination Survey, linked with National Death Index mortality files. Respondents reporting one or more same-sex sexual partners in their lifetime or who identified as gay, lesbian, or bisexual were considered sexual minority adults (617 sexual minority males and 963 sexual minority females).

Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality.

Objectives: This study explores the effect of Medicaid expansion under the Affordable Care Act on the maternal mortality ratio in the United States.

Methods: A difference-in-differences research design was used to analyze the effect of Medicaid expansion on maternal mortality. Maternal mortality was defined with and without late maternal deaths, to substantiate the contribution of increased preconception and postpartum insurance coverage.