A recent study by Columbia University’s Mailman School of Public Health reveals that Medicaid extension policies introduced after the COVID-19 pandemic have significantly reduced postpartum uninsurance in New York City. However, the research points to a concerning gap in awareness that may have limited the benefits for Hispanic immigrant populations.
The study, published in the American Journal of Public Health, found that continuous Medicaid enrollment during the Families First Coronavirus Response Act (FFCRA) led to a 4 percentage-point decrease in postpartum uninsurance among immigrants in New York City. While this marked an improvement, the study noted that it did not entirely close the insurance gap between U.S.-born individuals and immigrants.
Nationwide, a prior study by Columbia Mailman revealed a drop in uninsurance rates from 10% in 2019 to 3.7% in 2021, with a rise in preventive postpartum care utilization. Despite these advances, Dr. Teresa Janevic, an associate professor of Epidemiology at Columbia, emphasized the need for community-driven strategies to raise awareness and ensure that all eligible individuals benefit from these policies.
Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), the study examined postpartum insurance rates among Medicaid recipients in New York City before and after the FFCRA. The analysis included 2,611 Medicaid-paid births from 2016-2019 and 1,197 births from 2020-2021. For immigrant populations, postpartum uninsurance fell from 13.6% to 9.3%, while the rate for U.S.-born individuals decreased from 1.2% to 0.7%. Although the reduction in uninsurance was observed across all immigrant groups, the decline was less pronounced among Hispanic immigrants, whose uninsurance rate decreased from 23.5% to 18%.
Despite continued eligibility, 1 in 6 Hispanic immigrants reported being uninsured during the FFCRA period. Sociodemographic factors such as length of time in the U.S., race/ethnicity, and education level were identified as contributors to these disparities.
In New York City, Hispanic and Black populations face significantly higher risks of pregnancy-related deaths compared to non-Hispanic white populations, and the loss of Medicaid coverage post-birth may exacerbate these inequities. Dr. Janevic explained that many Hispanic immigrants were unaware of their continued Medicaid eligibility, highlighting a persistent barrier to coverage. The COVID-19 pandemic also saw a sharp 41% rise in postpartum maternal mortality in 2020, with the largest increase among Hispanic individuals, underscoring the need for action.
The researchers advocate for targeted communication strategies to address these knowledge gaps, such as collaborations with community-based organizations and federally qualified health centers. However, they caution that anti-immigrant sentiment and fear of accessing benefits may hinder these efforts.
The findings also carry national significance, as 47 states have extended postpartum Medicaid. Of these, New York and 11 others have included all enrollees, regardless of immigration status, showing marked improvements in postpartum insurance coverage. In contrast, states that exclude certain immigrant groups may not see the same positive outcomes.
This study, co-authored by experts from multiple institutions, underscores the critical need for continued outreach and support to ensure that all eligible immigrants benefit from Medicaid extension policies and access vital maternal health services.
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