Postpartum Medicaid extensions and follow-up care after pregnancy complications.

Introduction: For women with pregnancy complications, such as hypertensive disorders or gestational diabetes, the postpartum period is a critical, yet underutilized opportunity to prevent both pregnancy-related morbidity and longer-term chronic disease. Loss of insurance coverage postpartum is a barrier to treatment and prevention strategies. Methods: We examined if extending Medicaid through 12 months postpartum increased postpartum health care utilization for women with pregnancies complicated by diabetes or hypertension. We analyzed 2019-2023 deliveries in Medicaid claims data from New York (NY) and Texas (TX) using an interrupted time series design and segmented regression analysis. Results: We found that postpartum diabetes screening and outpatient utilization increased during the continuous enrollment provision (CEP) of the COVID-19 public health emergency, decreased during unwinding of the CEP in TX, and increased after implementation of postpartum extension legislation in NY. Postpartum hypertensive medication prescriptions increased slightly in TX and saw no change in NY. Conclusion: Given that NY and TX are states with large Medicaid-insured populations and diverse policy climates, the consistency of our findings suggests that postpartum extension of Medicaid is an effective strategy to increase follow-up care among Medicaid beneficiaries with pregnancy complications.