Severe Postpartum Maternal Morbidity: How Medicaid Coverage for 365 Days Can Make a Difference.

Objective Severe maternal morbidity (SMM) poses a public health dilemma. To ensure continuity of care for 12 months postpartum, the American Rescue Plan Act of 2021 permitted states to extend Medicaid postpartum coverage to 12 months. This study describes the experiences of a major national insurer in the United States. Methods A medical claims and member eligibility dataset was created from a major national insurer over a 10-year period (January 1 2014, to December 31 2023). An individual's eligibility for Medicaid insurance and ability to enroll in a major national insurer in the United States is based on several factors, including (1) age; (2) income level; (3) number of family members; and (4) whether the individual is pregnant or has a disability. The inclusion criteria in our study consisted of four qualifications: (1) the pregnancy resulted in a delivery; (2) the enrollee retained eligibility with the major national insurer for the full 365 days postpartum; (3) the enrollee did not become pregnant within 365 days postpartum; and (4) the enrollee did not die within 365 days postpartum. The total postpartum episodes refer to any pregnancy that resulted in a delivery. A postpartum episode was labeled as having an SMM when a diagnosis was observed two days prior to the delivery through 365 days postpartum. The timing of SMM was determined according to the first date of service associated with the SMM diagnosis in question. The statistical analysis was performed utilizing Wilcoxon rank sum tests for continuous variables and the chi-squared tests for categorical variables. Results Of the 105,654 total postpartum episodes, 3,396 SMM episodes were reported, reflecting 3.2% of the overall number of episodes. The most common SMM conditions were sepsis (999 (29.4%) episodes), acute respiratory distress syndrome (593 (17.5%) episodes), pulmonary edema/acute heart failure (532 (15.7%) episodes), and acute renal failure (531 (15.6%) episodes). A total of 1698 (50%) cases of all SMM presented prior to nine days, and 849 (25%) presented after 131 days. The proportion of those with an older age (29 (IQR = 24-34) years vs. 27 (IQR = 23-32) years), preterm birth (1032 (30.4%) vs. 11,817 (11.6%)), cesarean section (1769 (52.1%) vs. 33,136 (32.4%)), and a depression diagnosis within 12 months postpartum (1081 (31.8%) vs. 20,385 (19.9%)) was higher in individuals with SMM compared to individuals without SMM. Conclusion Determining the presence and specific timing of postpartum SMM is critical for intervention by case managers. Expanding Medicaid coverage through the first year postpartum offers a valuable opportunity to monitor healthcare access and manage women with potentially life-threatening pregnancy complications.