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. We examined postpartum insurance patterns and used logistic regression to assess the association between postpartum insurance instability and mental health care access.

Results: Insurance changes primarily occurred by 3-6 months postpartum. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage (p < .001). Respondents who were younger, had incomes of less than $50,000, and were of Hispanic ethnicity were more likely to experience unstable postpartum insurance. Respondents who experienced postpartum insurance instability had a lower odds of reporting that they discussed mental health at a postpartum check-up (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.7; p < .01) and received postpartum mental health services (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.9; p < .05).

Conclusions: The majority of postpartum insurance disruptions occurred among respondents with public coverage at childbirth and by 3-6 months postpartum. Respondents who experienced unstable coverage were more likely to have less access to postpartum mental health care. Policies that increase postpartum insurance stability, such as postpartum Medicaid extensions beyond 60 days, are needed to improve access to postpartum mental health services.