Several federal and state policy changes altered the coverage landscape for new mothers during the 2019–24 period. These included the pandemic-era continuous coverage requirement in Medicaid, which mandated that states not disenroll Medicaid enrollees during the COVID-19 public health emergency, and the unwinding of this requirement; extensions of postpartum Medicaid and Children’s Health Insurance Program coverage; additional states adopting the Affordable Care Act (ACA) Medicaid expansion; and increased affordability of Marketplace coverage through enhanced tax credits.

This brief provides national estimates of uninsurance among new mothers from 2019 to 2024, based on data from the American Community Survey. We also assess changes in coverage types among new mothers, as well as changes in uninsurance rates by state Medicaid expansion status, state, and demographic and socioeconomic characteristics.

Why This Matters

The US experiences high rates of maternal morbidity and mortality, and with most maternal deaths occurring after delivery, attention has increasingly focused on the role of insurance coverage in promoting access to health care in the postpartum period. Uninsurance and churn into and out of coverage can worsen access to health care, disrupt continuity of care, and create financial and psychological burdens.

What We Found

• The uninsurance rate among new mothers fell by 23 percent between 2019 and 2023, declining from 11.7 percent to 9.0 percent. However, coverage gains stalled in 2024, and 9.2 percent of new mothers (an estimated 347,000 individuals) were uninsured in that year.
• Declining uninsurance corresponded with gains in Medicaid and private nongroup coverage (including Marketplace coverage) between 2019 and 2023, likely related to the Medicaid continuous coverage requirement, postpartum extensions, additional states adopting the ACA Medicaid expansion, and the availability of enhanced Marketplace subsidies. Between 2019 and 2023, Medicaid coverage among new mothers rose from 28.1 percent to 30.8 percent, while nongroup coverage rose from 4.7 percent to 5.4 percent. However, while nongroup coverage rose by 0.4 percentage points in 2024, likely driven in part by the enhanced tax credits for Marketplace coverage, Medicaid coverage fell by 0.8 percentage points, from 30.8 percent in 2023 to 29.6 percent in 2024, which was likely related to the unwinding of the Medicaid continuous coverage requirement.
• When examining coverage changes by groups of states classified by whether and when they had adopted the Medicaid expansion and by region, we found that reductions in uninsurance occurred in all state groups but were concentrated in nonexpansion states and in the states that adopted the ACA Medicaid expansion between 2019 and 2024, as well as in the South and West. These changes narrowed coverage gaps across state groups, but new mothers’ uninsurance in 2024 remained higher in nonexpansion states and in the South.
• Declines in uninsurance in states that adopted the ACA Medicaid expansion between 2019 and 2024 were driven primarily by Medicaid coverage increases, while declines in uninsurance in nonexpansion states reflected increases in both Medicaid and Marketplace coverage.
• Variation in uninsurance among new mothers persisted across states. For instance, in 2023–24, uninsurance rates for new mothers varied nearly 10-fold across states, ranging from a low of 2.2 percent in Massachusetts to a high of 21.1 percent in Texas.
• Most of the subgroups we examined experienced coverage gains between 2019 and 2024, and coverage gaps narrowed by race/ethnicity, citizenship status, and income. Still, in 2024, 19.6 percent of American Indian/Alaska Native new mothers and 18.9 percent of Hispanic new mothers were uninsured, compared with 5 to 8 percent of new mothers who were non-Hispanic and Asian/Pacific Islander, Black, white, or other or multiple races. Noncitizen new mothers remained over three times more likely than citizen new mothers to be uninsured, and mothers with incomes below 200 percent of FPL remained nearly twice as likely to be uninsured as those with higher incomes.

How We Did It

We use data from the 2019 and 2021–24 American Community Survey to assess insurance coverage for new mothers ages 19 to 44. We classify new mothers as women in this age group who reported giving birth in the past year and who do not live in group quarters. We considered a respondent to be uninsured if they reported having no health insurance coverage at the time of the survey.