Postpartum Health Care Utilization and Contraception Uptake in Wisconsin

The postpartum visit is an opportunity to address health risks that may have arisen or worsened during pregnancy, postpartum depression, and women’s family planning goals. However, the proportion of Medicaid recipients that attend their postpartum visit is unclear. In many states, some women are only covered by Medicaid during pregnancy and through 60 days postpartum. To date, there have not been any published studies examining the effect of having continuous Medicaid eligibility versus pregnancy-only Medicaid eligibility on the use of postpartum care or postpartum contraception. This study used Medicaid data for women who delivered at least one live birth between 2011 and 2015 in Wisconsin, linked to the birth certificate of the infant and to the woman’s Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire, if applicable. The three aims were: 1) to triangulate postpartum health care utilization from Medicaid and PRAMS data; 2) to compare patterns of postpartum health care utilization for women with continuous eligibility versus pregnancy-only Medicaid; and 3) to compare postpartum contraception receipt for women with continuous eligibility versus pregnancy-only Medicaid. Most women in the sample had claims for postpartum care at some point in the first 12 weeks postpartum, but the timing of these visits was somewhat unclear due to the use of bundled codes. The agreement between Medicaid claims and PRAMS was poor, although it was substantially higher when bundled codes for postpartum care were included. Women with continuous Medicaid eligibility were more likely to receive routine postpartum care and most or moderately effective methods of postpartum contraception in the first 12 weeks postpartum than women with pregnancy-only Medicaid. These relationships persisted after adjusting for maternal characteristics of interest. Receiving no prenatal care was a strong predictor of not receiving postpartum care and postpartum contraception. The results of this study suggest the need for innovative ways to increase access to postpartum care and postpartum contraception for women with Medicaid-paid births. One such opportunity could be to expand Medicaid coverage from 60 days to one year postpartum. However, further research is needed to improve measurement of postpartum care and postpartum contraception utilization from Medicaid claims.