Medicaid Continuous Coverage Requirement and Postpartum Hospitalization.

Importance: In 2020, all US states adopted the Families First Coronavirus Response Act Medicaid continuous coverage requirement (CCR), which prevented disenrollment from Medicaid. This policy effectively extended pregnancy-related Medicaid eligibility beyond the previous end date of 60 days post partum. Objective: To determine whether the CCR was associated with a change in postpartum hospitalization rates for mothers covered by Medicaid during their delivery. Design, Setting, and Participants: This cohort study was conducted from December 2023 to March 2025 at all nonfederal acute care hospitals in 20 states using data from the Healthcare Cost and Utilization Project's State Inpatient Databases from 2018 through 2021. Participants included mothers aged 18 to 55 years who had Medicaid-paid deliveries (based on the primary expected payer) from January 2018 to June 2021; they were followed up for 180 days post partum. Exposures: State-level postpartum uninsured rate among mothers with Medicaid-paid deliveries that occurred from 2018 to 2019 (before the CCR was implemented in 2020). Residency in states with an uninsured rate above the median was considered to be high exposure (ie, a greater share of the state population had the potential to benefit from the CCR) and residency in states with a preperiod uninsured rate below the median was considered low exposure. Main Outcomes and Measures: Probability of a mother being hospitalized 1 to 60 days post partum (covered under previous Medicaid eligibility rules) and 61 to 180 days post partum (newly covered under the CCR). Results: A total of 2 024 214 mothers (mean age, 27.5 [95% CI, 27.5-27.5] years) with Medicaid-paid deliveries were identified. The sample included 550 881 deliveries by Hispanic mothers (27.2%), 490 586 deliveries by non-Hispanic Black mothers (24.2%), 744 945 deliveries by non-Hispanic White mothers (36.8%), 200 639 deliveries by mothers of other races and ethnicities (9.9%), and 37 163 deliveries by mothers with missing race and ethnicity data (1.8%). Among the full sample, 931 452 mothers (mean age, 27.1 [95% CI, 27.71-27.2] years) resided in high-exposure states and 1 092 762 mothers (mean age, 27.8 [95% CI, 27.8-27.8] years) resided in low-exposure states. In adjusted difference-in-differences models, the rate of hospitalization per 1000 Medicaid-paid deliveries at 61 to 180 days post partum decreased (adjusted β coefficient, -1.4; 95% CI, -2.5 to -0.3) in high-exposure states compared with low-exposure states, a 10.9% decrease relative to the preperiod mean (12.9; 95% CI, 12.6 to 13.2) in high-exposure states. The analogous estimate for the hospitalization rates 1 to 60 days post partum was not statistically significant (-0.7 [95% CI, -2.0 to 0.5] per 1000 Medicaid-paid deliveries). Conclusions and Relevance: Findings of this study suggest that residency in high-exposure states was associated with a reduction in hospitalizations for mothers 61 to 180 days post partum (the period newly covered by extended Medicaid coverage). Extended Medicaid coverage may help to improve postpartum health and reduce adverse events among mothers with low income.