Study Underscores Importance of Medicaid Coverage for Pregnant Women

A study released by the Elevance Health Public Policy Institute is confirming what some healthcare policy experts and health equity advocates have been saying for many years: that continuous Medicaid coverage for pregnant women through the entirety of their pregnancies, is important with regard to health outcomes.

The study, entitled “Late Medicaid Enrollment During Pregnancy Increases Risk of Mortality,” was published earlier this month by the Elevance Health Public Policy Institute, created by the Indianapolis-based Elevance Health (formerly Anthem), the largest for-profit Blue Cross health plan, which insures more than 46.8 million Americans.

As the report states, “Advanced maternal age, preexisting health conditions such as diabetes or high blood pressure, and previous pregnancy complications are some of the factors associated with high-risk pregnancies, potentially leading to adverse birth outcomes. Having health insurance during the entirety of pregnancy promotes access to care providers who can assess and mitigate identified risks early in the perinatal period.”

The report lists the following key takeaways:

• Pregnant women who enrolled in a Medicaid managed care plan in the third trimester, versus in the first trimester, have a significantly higher risk for all-cause mortality within six weeks post-delivery.

• Enrollment in the third versus first trimester is also associated with a higher risk of infant mortality over the first year of life.

• These findings suggest that earlier enrollment in a Medicaid plan can support timely diagnosis and care for conditions associated with risk of adverse outcomes during delivery and postpartum.

The report notes that, “Although it is well-established that access to early prenatal care is associated with better health outcomes for women and infants, disparities in access to prenatal care persist in the U.S., particularly among younger, rural, and underrepresented maternal populations, which are more often Medicaid beneficiaries.6-8 Women enrolled in Medicaid have lower rates of timely prenatal care initiation, with 66 percent in 2022 having a prenatal care visit in the first trimester compared to 85 percent of commercially insured women.9 The proportion of Medicaid beneficiaries who receive prenatal care in the first trimester also varies by state. Vermont and Rhode Island have the two highest proportions with 81 and 78 percent, respectively, receiving care in trimester one. Several states recorded rates below 60 percent: Arkansas, Florida, Hawaii, Maryland, South Dakota, Texas, and Washington, D.C.”

 The report states that “A lack of timely and adequate prenatal care is a missed opportunity for identifying health risks that can lead to adverse outcomes for both mothers and infants. An estimated 60 percent of pregnancy-related maternal deaths are preventable, with access to prenatal care being a contributing factor.10 Relatedly, the absence of prenatal care is associated with higher infant mortality rates (i.e., a death of an infant within the first year of life). Ultimately, prenatal care is not only for short-term clinical care, but also to promote long-term health for both the mother and infant.”