In March 2020, the Families First Coronavirus Response Act established a continuous coverage requirement mandating states not disenroll people from Medicaid, including those with pregnancy-related coverage, during the public health emergency. Historically, pregnancy-related Medicaid coverage expired just 60 days after the end of pregnancy, but the continuous coverage requirement allowed new mothers with pregnancy-related Medicaid coverage to remain continuously insured.

In this brief, we use 2016–2019 and 2021 American Community Survey data to examine trends in uninsurance among new mothers just before and during the public health emergency and Medicaid continuous coverage requirement.

WHY THIS MATTERS

Ensuring new mothers have health insurance coverage and the coverage includes access to affordable, high-quality, culturally effective care that meets their health needs is important for their health and well-being and the health, development, and well-being of their infants and families.

With the expiration of the continuous coverage requirement as of April 1, 2023, states have begun to resume the process of redetermining eligibility for all enrollees, which could put at risk coverage gains that occurred between 2019 and 2021.

At the same time, recent federal policy changes gave states a new option to extend coverage in the postpartum period. As of 2023, most states have adopted postpartum extensions, continuing pregnancy-related Medicaid/Children’s Health Insurance Program (CHIP) coverage for 12 months postpartum.

Understanding coverage changes under the continuous coverage requirement could inform state decisionmaking on the unwinding of pandemic protections and on adopting and implementing postpartum extensions and effective rollouts of related policies to improve coverage continuity more generally.

WHAT WE FOUND

• After relative stability between 2016 and 2019, uninsurance among new mothers fell by 14 percent between 2019 and 2021, despite rising unemployment.
  • While uninsurance fell among new mothers, Medicaid coverage increased from 28.1 percent to 31.1 percent between 2019 and 2021.
  • Despite this progress, 1 in 10 new mothers were uninsured in 2021, which places them at higher risk of experiencing unmet health needs and financial burdens.
• Improvements in coverage between 2019 and 2021 were large among some subgroups of new mothers who experienced lower rates of insurance coverage in 2019, but stark disparities remained by income, race and ethnicity, and citizenship status.
• While increases in new mothers’ insurance coverage between 2019 and 2021 were concentrated in states that did not expand Medicaid under the Affordable Care Act and in the South, new mothers in those states continued to be at substantially higher risk of being uninsured in 2021.
  • New mothers living in nonexpansion states were 2.3 times more likely to be uninsured (15.9 percent) in 2021 than those living in states that had expanded Medicaid under the Affordable Care Act (6.9 percent).
• In 2021, there was substantial state variation in uninsurance rates for new mothers among the 36 states where annual estimates could be reliably calculated. Four states (Massachusetts, Michigan, Minnesota, and New York) had rates below 5 percent. In comparison, three states (Georgia, Oklahoma, and Texas) had rates above 15 percent, with the highest rate (23.8 percent) found in Texas, which accounted for over one in four of the nation's uninsured new mothers in 2021.
• More than half of uninsured new mothers in 2021 lived in nonexpansion states and in the South.

HOW WE DID IT

This analysis uses 2016–2019 and 2021 American Community Survey data to examine trends in uninsurance among new mothers, focusing primarily on changes between 2019 and 2021 to assess patterns just before and during the COVID-19 pandemic and Medicaid continuous coverage requirement. We investigate changes in rates of uninsurance among new mothers overall, by socioeconomic and demographic subgroups, and by state characteristics. We also assess the socioeconomic, demographic, and state policy characteristics of uninsured new mothers in 2021 and compare these characteristics with those of all new mothers.