Study reveals: high Medicaid disenrollment patterns after individuals give birth

More than 600,000 people are disenrolled from Medicaid each year after giving birth, according to a new analysis from the Kaiser Family Foundation. Researchers say disenrollment could be prevented if all states were to take up a new option to extend Medicaid postpartum coverage to 12 months.

KFF’s estimate, based on analysis of Medicaid claims data from 2018, finds that 610,000 postpartum women were disenrolled within a year of giving birth, accounting for about 40% of the 1.5 million Medicaid enrollees with live births that year. A new federally funded state option to extend postpartum care was created by a provision in the American Rescue Plan Act of 2021 (ARPA). The new option took effect on April 1, 2022, and is available to states for five years.

The option — adopted by 33 states so far, according to KFF — is receiving renewed attention amid rising maternal mortality rates and following the Supreme Court’s decision to overturn Roe v. Wade. KFF researchers claim that state policy decisions about Medicaid postpartum coverage could be especially impactful in states set to restrict abortion access, since the high court’s ruling could affect the number of births in the U.S. covered by Medicaid.

Federal law only requires states to provide pregnancy-related Medicaid coverage through 60 days following childbirth, after which some enrollees may lose coverage if their income is too high to qualify for Medicaid through some other eligibility pathway.

“Thousands of people experiencing a pregnancy loss could also benefit from a 12-month postpartum coverage,” according to the authors of the analysis. “We estimate that at least 50,000 enrollees with a pregnancy loss in 2018 were disenrolled in the postpartum year but would have otherwise stayed continuously enrolled if all states had implemented a 12-month coverage extension. Our estimate is likely an undercount, because individuals who did not seek medical attention for a miscarriage would not be identifiable in the claims data used in this analysis and because we limited our estimate to individuals who had pregnancy as their primary eligibility pathway when their pregnancy loss occurred.”

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KFF researchers found that among Medicaid enrollees with a live birth in 2018, 31% were disenrolled within six months after delivery and 40% were disenrolled within a year. Among those who were disenrolled within a year, 1 in 4 (26%) subsequently re-enrolled in Medicaid during that same 12-month period following delivery. This phenomenon, known as “churn,” can sometimes indicate that administrative barriers, rather than ineligibility, were behind the coverage loss, they add.