New York— A new study at Columbia University Mailman School of Public Health reveals that Medicaid extension policies, which cover all immigrants in the post-COVID era, have led to a notable reduction in postpartum uninsurance, particularly in New York City. However, the study highlights that awareness gaps may have hindered the full benefit for Hispanic immigrants. The results are published in the American Journal of Public Health (AJPH).
Continuous Medicaid enrollment during the Families First Coronavirus Response Act (FFCRA) was associated with a 4 percentage-point decrease in postpartum uninsurance among immigrant populations in New York City. This led to a reduction, though not complete elimination, of the insurance gap between immigrant and U.S.-born populations. An earlier study from Columbia Mailman School of Public Health conducted on a national scale revealed that continuous Medicaid coverage during the FFCRA period helped reduce uninsurance rates from 10 percent in 2019 to 3.7 percent in 2021, with an increase in the use of preventive postpartum services among Medicaid beneficiaries.
"While postpartum Medicaid extension policies that include all immigrants help reduce inequities, it is still critical to implement community-based strategies to raise awareness of coverage and promote maternal health equity," said Teresa Janevic, PhD, associate professor of Epidemiology at Columbia Mailman School.
The study examined postpartum insurance rates among Medicaid-paid births in New York City using the Pregnancy Risk Assessment Monitoring System (PRAMS). Researchers assessed uninsurance rates for individuals 2 to 6 months postpartum, comparing the pre-FFCRA period (2016-2019) with the post-FFCRA period (2020-2021). The analysis included 2,611 Medicaid-paid births in the pre-FFCRA period and 1,197 births from 2020 to 2021 post-FFCRA.
Among immigrant populations, postpartum uninsurance dropped from 13.6% to 9.3% following FFCRA, while the rate for U.S.-born individuals decreased from 1.2 percent to 0.7 percent Although uninsurance decreased across all immigrant groups, the decline was least pronounced among Hispanic immigrants, who saw a reduction from 23.5 percent to 18 percent. In fact, 1 in 6 Hispanic immigrants reported being uninsured during the FFCRA period despite continuing eligibility for coverage. Sociodemographic analyses showed differences in uninsurance based on years in the U.S., race/ethnicity, and education level.
In New York City, Hispanic and Black populations face 2- and 6-fold higher risks of pregnancy-related deaths, respectively, compared to non-Hispanic White populations. These inequities extend into the postpartum period, and the loss of Medicaid coverage after birth may contribute to these disparities.
"The finding that many Hispanic immigrants were unaware of their continued Medicaid coverage suggests that knowledge gaps about Medicaid eligibility—particularly related to immigration status—remain a critical barrier," explained Janevic. "In 2020, postpartum maternal mortality rose by 41 perent during the COVID-19 pandemic, with the largest increase seen among Hispanic individuals. This underscores the urgent need to bridge these knowledge gaps."
To address these challenges, the researchers suggest targeted communication strategies, such as partnering with community-based organizations and federally qualified health centers, to disseminate information about Medicaid coverage. However, these efforts may face challenges due to ongoing anti-immigrant sentiment in the U.S. and the fear some immigrant communities face accessing benefits for which they are eligible.
The study's results also carry national significance. Of the 47 states that extended postpartum Medicaid, New York and 11 other states include all enrollees, regardless of immigration status. The study shows that these states have made significant gains in improving postpartum insurance coverage. In contrast, states that exclude certain immigrant groups may not see similar benefits.
Co-authors of the study include Lauren Birnie, Kizzi Belfon, Lily Glenn, and Folake Eniola, New York City Department of Health and Mental Hygiene; Sheela Maru, Heeun Kim, and Ellerie Weber, Icahn School of Medicine at Mount Sinai; Simone Reynolds, SUNY Downstate Health Sciences University; and Ashley Fox, SUNY Albany Rockefeller College of Public Affairs and Policy.
The study was supported by the Robert Wood Johnson Foundation (grant #79625). The authors report no conflicts of interest.
Columbia University Mailman School of Public Health
