State Public Insurance Coverage Policies and Postpartum Care Among Immigrants.

Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE

Original Publication: Chicago : American Medical Association, 1960-

Emigrants and Immigrants*/legislation & jurisprudence ; Emigrants and Immigrants*/statistics & numerical data ; Health Services Accessibility*/legislation & jurisprudence ; Health Services Accessibility*/statistics & numerical data ; Insurance Coverage*/legislation & jurisprudence ; Insurance Coverage*/statistics & numerical data ; Medicaid*/legislation & jurisprudence ; Medicaid*/statistics & numerical data ; Postnatal Care*/legislation & jurisprudence ; Postnatal Care*/statistics & numerical data ; Health Policy*/legislation & jurisprudence; Adult ; Female ; Humans ; Pregnancy ; Cross-Sectional Studies ; Insurance, Health/legislation & jurisprudence ; Insurance, Health/statistics & numerical data ; Public Policy/legislation & jurisprudence ; United States/epidemiology ; Poverty/statistics & numerical data ; Undocumented Immigrants/legislation & jurisprudence ; Undocumented Immigrants/statistics & numerical data

Importance: Professional medical organizations recommend that adults receive routine postpartum care. Yet, some states restrict public insurance coverage for undocumented immigrants and recently documented immigrants (those who received legal documentation status within the past 5 years).
Objective: To examine the association between public insurance coverage and postpartum care among low-income immigrants and the difference in receipt of postpartum care among immigrants relative to nonimmigrants.
Design, Setting, and Participants: A pooled, cross-sectional analysis was conducted using data from the Pregnancy Risk Assessment Monitoring System for 19 states and New York City including low-income adults with a live birth between 2012 and 2019.
Exposure: Giving birth in a state that offered public insurance coverage for postpartum care to recently documented or undocumented immigrants.
Main Outcomes and Measures: Self-reported receipt of postpartum care by the category of coverage offered (full coverage: states that offered publicly funded postpartum care regardless of immigration status; moderate coverage: states that offered publicly funded postpartum care to lawfully residing immigrants without a 5-year waiting period, but did not offer postpartum care to undocumented immigrants; no coverage: states that did not offer publicly funded postpartum care to lawfully present immigrants before 5 years of legal residence or to undocumented immigrants).
Results: The study included 72 981 low-income adults (20 971 immigrants [29%] and 52 010 nonimmigrants [71%]). Of the 19 included states and New York City, 6 offered full coverage, 9 offered moderate coverage, and 4 offered no coverage; 1 state (Oregon) switched from offering moderate coverage to offering full coverage. Compared with the states that offered full coverage, receipt of postpartum care among immigrants was 7.0-percentage-points lower (95% CI, -10.6 to -3.4 percentage points) in the states that offered moderate coverage and 11.3-percentage-points lower (95% CI, -13.9 to -8.8 percentage points) in the states that offered no coverage. The differences in the receipt of postpartum care among immigrants relative to nonimmigrants were also associated with the coverage categories. Compared with the states that offered full coverage, there was a 3.3-percentage-point larger difference (95% CI, -5.3 to -1.4 percentage points) in the states that offered moderate coverage and a 7.7-percentage-point larger difference (95% CI, -10.3 to -5.0 percentage points) in the states that offered no coverage.
Conclusions and Relevance: Compared with states without insurance restrictions, immigrants living in states with public insurance restrictions were less likely to receive postpartum care. Restricting public insurance coverage may be an important policy-driven barrier to receipt of recommended pregnancy care and improved maternal health among immigrants.

Erratum in: JAMA. 2023 Sep 5;330(9):880. (PMID: 37668638)

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P2C HD041020 United States HD NICHD NIH HHS; R21 HD103943 United States HD NICHD NIH HHS

Date Created: 20230718 Date Completed: 20230724 Latest Revision: 20240119

20240119

PMC10354679

10.1001/jama.2023.10249

37462705