The impact of Medicaid expansion on postpartum health care utilization among pregnant women with opioid use disorder

Abstract

Background: Opioid use disorder (OUD) during pregnancy has increased dramatically over the past decade, as have associated adverse maternal health outcomes. Although Medicaid has long been the largest payer for deliveries in the United States, states’ decisions to expand Medicaid eligibility to low-income adults has the potential to increase access to care for women in the postpartum period. This study aimed to determine the impact of the 2015 Pennsylvania Medicaid expansion on postpartum insurance coverage and preventive care utilization among pregnant women with opioid use disorder (OUD). Methods: In 2017, we conducted a retrospective cohort study using 2013–2015 administrative Medicaid data provided by the Pennsylvania Department of Human Services. We identified 1562 women with opioid use disorder who had a live birth delivery in a pre-Medicaid expansion or post-expansion study period. We compared length of continuous enrollment in Medicaid following delivery, postpartum visit attendance, and contraception initiation between groups. Results: More women in the post-expansion group remained enrolled in Medicaid at 300 days postpartum, relative to the pre-expansion group (87% vs. 81%). Medicaid expansion was not associated with differences in postpartum visit attendance or contraceptive use. However, women who remained enrolled in Medicaid for at least 300 days post delivery had an increased odds of postpartum visit attendance (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.04, 2.4). Conclusion: The rate of continuous Medicaid enrollment among postpartum women with OUD was significantly higher after expansion, whereas rates of preventive care utilization were unaffected. Although improving insurance coverage for women with OUD is an important step to improve access to recommended preventive care, additional efforts are needed to ensure utilization of such care.

Keywords:

• Maternal health;
• medicaid;
• opioid-related disorders

Author contributions

The study was designed by Dr. Marian Jarlenski, Briana Patton, and Dr. Elizabeth Krans. The analysis was performed by Briana Patton with guidance from Joo Yeon Kim and Marian Jarlenski. The manuscript was written by Briana Patton with assistance from Marian Jarlenski and Elizabeth Krans.

Additional information

Funding

The work of Dr. Elizabeth Krans, Dr. Marian Jarlenski, and Joo Yeon Kim was supported by the Building Interdisciplinary Research Careers in Women’s Health program (Jarlenski; K12 HD043441), the National Institute on Drug Abuse (Krans; K23 DA038789), and by an intergovernmental agreement between the Pennsylvania Department of Human Services and the University of Pittsburgh. The work of Briana Patton was supported by a medical student research grant from the University of Pittsburgh School of Medicine. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.