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- Title
Differences in Self-Reported and Billed Postpartum Visits Among Medicaid-Insured Individuals.
- Authors
Bellerose, Meghan; Daw, Jamie R.; Steenland, Maria W.
- Abstract
This cross-sectional study investigates the association of transitions in health care coverage with disagreement in postpartum visit use in self-reports and Medicaid claims. Key Points: Question: Do transitions in health insurance coverage between delivery and the postpartum period contribute to differences in self-reported and claims-based estimates of postpartum care use? Findings: In this cross-sectional study of 836 individuals in the postpartum period, 27.2% of respondents with Medicaid at delivery self-reported a postpartum visit but did not have a Medicaid claim for a visit. The greatest differences were among people who transitioned from Emergency Medicaid at delivery to no insurance after delivery and Medicaid at delivery to private insurance after delivery. Meaning: These findings suggest that estimates of postpartum care use that are used to inform state Medicaid policy decisions could be strengthened by accounting for insurance transitions after delivery. Importance: State Medicaid programs have recently implemented several policies to improve access to health care during the postpartum period. Understanding whether these policies are succeeding will require accurate measurement of postpartum visit use over time and across states; however, current estimates of use vary substantially between data sources. Objectives: To examine disagreement between postpartum visit use reported in the Pregnancy Risk Assessment Monitoring System (PRAMS) and Medicaid claims and assess whether insurance transitions from Medicaid at the time of childbirth to other insurance types after delivery are associated with the degree of disagreement. Design, Setting, and Participants: This cross-sectional study was conducted among individuals in South Carolina after delivery who had completed a PRAMS survey and for whom Medicaid was the payer of their delivery care. PRAMS responses from 2017 to 2020 were linked to inpatient, outpatient, and physician Medicaid claims; survey-weighted logistic regression models were then used to examine the association between postpartum insurance transitions and data source disagreement. Data were analyzed from February through October 2023. Exposure: Insurance transition type: continuous Medicaid, Medicaid to private insurance, Medicaid to no insurance, and Emergency Medicaid to no insurance. Main Outcome and Measure: Data source disagreement due to reporting a postpartum visit in PRAMS without a Medicaid claim for a visit or having a Medicaid claim for a visit without reporting a postpartum visit in PRAMS. Results: Among 836 PRAMS respondents enrolled in Medicaid at delivery (663 aged 20-34 years [82.9%]), a mean of 85.7% (95% CI, 82.1%-88.7%) reported a postpartum visit in PRAMS and a mean of 61.6% (95% CI, 56.9%-66.0%) had a Medicaid claim for a postpartum visit. Overall, 253 respondents (30.3%; 95% CI, 26.1%-34.7%) had data source disagreement: 230 individuals (27.2%; 95% CI, 23.2%-31.5%) had a visit in PRAMS without a Medicaid claim, and 23 individuals (3.1%; 95% CI, 1.8%-5.2%) had a Medicaid claim without a visit in PRAMS. Compared with individuals continuously enrolled in Medicaid, those who transitioned to private insurance after delivery and those who were uninsured after delivery and had Emergency Medicaid at delivery had an increase in the probability of data source agreement of 15.8 percentage points (95% CI, 2.6-29.1 percentage points) and 37.2 percentage points (95% CI, 19.6-54.8 percentage points), respectively. Conclusions and Relevance: This study's findings suggest that Medicaid claims may undercount postpartum visits among people who lose Medicaid or switch to private insurance after childbirth. Accounting for these insurance transitions may be associated with better claims-based estimates of postpartum care.
- Subjects
SOUTH Carolina; HEALTH insurance exchanges; MATERNAL health services; HEALTH services accessibility; CONFIDENCE intervals; SELF-evaluation; CROSS-sectional method; PRIVATE sector; HEALTH insurance reimbursement; DESCRIPTIVE statistics; RESEARCH funding; POSTNATAL care; MEDICAL appointments; MEDICAID; DELIVERY (Obstetrics); LOGISTIC regression analysis; INSURANCE
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2349457
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.49457