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Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits
BACKGROUND: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9563385/ https://www.ncbi.nlm.nih.gov/pubmed/36274968 http://dx.doi.org/10.1016/j.xagr.2021.100030 |
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author | Rodriguez, Maria I. McConnell, K. John Skye, Megan Kaufman, Menolly Caughey, Aaron B. Lopez-Defede, Ana Darney, Blair G. |
author_facet | Rodriguez, Maria I. McConnell, K. John Skye, Megan Kaufman, Menolly Caughey, Aaron B. Lopez-Defede, Ana Darney, Blair G. |
author_sort | Rodriguez, Maria I. |
collection | PubMed |
description | BACKGROUND: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina. OBJECTIVE: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 states with similar-sized immigrant populations. STUDY DESIGN: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency) between January 1, 2010 and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (immediate postpartum, ≤1 month, 1–2 months, and 2–6 months after delivery) by the type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs Emergency) and postpartum visit attendance and contraception use were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort and conducted a subanalysis restricted to only Latina women. RESULTS: Our study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age >35 years; 18.1% vs 7.2%; P<.001) and were more likely to be multiparous (76.8% vs 60.8%; P<.001) and Latina (80.3% vs 9.5%; P<.001) than their Traditional Medicaid peers. Among women enrolled in Emergency Medicaid, the probability of having a postpartum visit was 6.1% (95% confidence interval, 5.9–6.4) compared with 58.8% (95% confidence interval, 58.6–58.9) for women covered by Traditional Medicaid. After 6 months following delivery, 97.6% of Emergency Medicaid recipients had no evidence of contraceptive use compared with 55.6% of Traditional Medicaid enrollees (P<.001). In our adjusted model, Emergency Medicaid recipients were also significantly less likely to receive postpartum contraception than Traditional Medicaid enrollees (1.9% vs 35.5%; 95% confidence interval, [1.8–2.1] vs [35.4–35.7]). We examined the role that race may play in postpartum contraceptive use by conducting a subanalysis restricted to Latina women only. Latinas with births covered by Emergency Medicaid had a 1.9% (95% confidence interval, 1.8–2.0) adjusted probability of postpartum contraception use within 2 months compared with 39.8% (95% confidence interval, 38.7–39.9) among Latinas enrolled in Traditional Medicaid. CONCLUSION: Women enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children. |
format | Online Article Text |
id | pubmed-9563385 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-95633852022-10-21 Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits Rodriguez, Maria I. McConnell, K. John Skye, Megan Kaufman, Menolly Caughey, Aaron B. Lopez-Defede, Ana Darney, Blair G. AJOG Glob Rep Original Research BACKGROUND: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina. OBJECTIVE: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 states with similar-sized immigrant populations. STUDY DESIGN: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency) between January 1, 2010 and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (immediate postpartum, ≤1 month, 1–2 months, and 2–6 months after delivery) by the type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs Emergency) and postpartum visit attendance and contraception use were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort and conducted a subanalysis restricted to only Latina women. RESULTS: Our study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age >35 years; 18.1% vs 7.2%; P<.001) and were more likely to be multiparous (76.8% vs 60.8%; P<.001) and Latina (80.3% vs 9.5%; P<.001) than their Traditional Medicaid peers. Among women enrolled in Emergency Medicaid, the probability of having a postpartum visit was 6.1% (95% confidence interval, 5.9–6.4) compared with 58.8% (95% confidence interval, 58.6–58.9) for women covered by Traditional Medicaid. After 6 months following delivery, 97.6% of Emergency Medicaid recipients had no evidence of contraceptive use compared with 55.6% of Traditional Medicaid enrollees (P<.001). In our adjusted model, Emergency Medicaid recipients were also significantly less likely to receive postpartum contraception than Traditional Medicaid enrollees (1.9% vs 35.5%; 95% confidence interval, [1.8–2.1] vs [35.4–35.7]). We examined the role that race may play in postpartum contraceptive use by conducting a subanalysis restricted to Latina women only. Latinas with births covered by Emergency Medicaid had a 1.9% (95% confidence interval, 1.8–2.0) adjusted probability of postpartum contraception use within 2 months compared with 39.8% (95% confidence interval, 38.7–39.9) among Latinas enrolled in Traditional Medicaid. CONCLUSION: Women enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children. Elsevier 2021-11-03 /pmc/articles/PMC9563385/ /pubmed/36274968 http://dx.doi.org/10.1016/j.xagr.2021.100030 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Research Rodriguez, Maria I. McConnell, K. John Skye, Megan Kaufman, Menolly Caughey, Aaron B. Lopez-Defede, Ana Darney, Blair G. Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits |
title | Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits |
title_full | Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits |
title_fullStr | Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits |
title_full_unstemmed | Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits |
title_short | Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits |
title_sort | disparities in postpartum contraceptive use among immigrant women with restricted medicaid benefits |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9563385/ https://www.ncbi.nlm.nih.gov/pubmed/36274968 http://dx.doi.org/10.1016/j.xagr.2021.100030 |
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