ABSTRACT
Objective
To estimate the effect of Medicaid continuous coverage provision (CCP) during the COVID-19 public health emergency on postpartum insurance for low-income noncitizen immigrants compared to citizens, and to assess whether state use of the from-conception-to-the-end-of-pregnancy (FCEP) policy, which excluded many immigrants from postpartum coverage, modified this effect.
Study Setting and Design
This study used a quasi-experimental design (difference-in-differences, or DID) to compare the insurance coverage gains between low-income postpartum noncitizens and citizens, using 2019 as the reference year. We further applied a triple difference (DDD) approach to assess the effect of the FCEP-only coverage policy, hypothesizing that noncitizens in states using FCEP as the sole pathway would experience smaller gains than in other states using various pathways to cover pregnant noncitizens otherwise ineligible.
Data Sources and Analytic Sample
Using the 2016–2022 American Community Survey individual-level data, we identified 61,572 low-income citizens (weighted N = 7,553,823) and 10,444 low-income noncitizens (weighted N = 1,487,373), with 8 FCEP-only states and 23 other states with various pathways.
Principal Findings
During the study period, the average postpartum uninsurance rate was 44.6% for noncitizens and 14.0% for citizens, while Medicaid coverage was 34.5% for noncitizens and 57.5% for citizens. Medicaid gains among noncitizens were statistically similar to gains among citizens in 2021 compared to 2019 in both FCEP-only states (DID = 2.3 percentage points [pp], 95% CI: −13.3, 8.7) and states with various pathways (DID = 4.6 pp, 95% CI: −1.2, 10.4), but these trends did not persist in 2022. We found no differences in insurance coverage gains among noncitizens between FCEP-only and states with various pathways.
Conclusions
Findings suggest that the CCP did not substantially reduce postpartum coverage inequities for noncitizen immigrants in either FCEP-only states or states with various pathways. Postpartum coverage inequities persisted under the CCPs, leaving many noncitizens uninsured.