Fragmented medicaid coverage and risk for adverse psychiatric outcomes through 9 months postpartum

Abstract

Mental health conditions (MHCs) and substance use disorders (SUDs) are a major cause of maternal morbidity and mortality in the late postpartum period. Historically many Medicaid beneficiaries have lost pregnancy-related coverage after 60 days postpartum. We evaluated the effect of fragmented Medicaid coverage on risk for adverse psychiatric outcomes through 9 months postpartum. We conducted a cross-sectional analysis of delivery hospitalizations with follow-up through 9 months included in the National Readmissions Database during 2010-2019. Using survey-adjusted logistic regression, we calculated odds ratios for the association between demographic and maternal factors and risk for first 9-month readmission with suicide attempt, non-fatal overdose, and/or a primary MHC/SUD diagnosis. Among first readmissions at 2-to-9 months receiving Medicaid at delivery, we evaluated the effect of discontinuation of coverage or switch to a non-Medicaid payer at rehospitalization (fragmentation) on risk for suicide attempt and non-fatal overdose. Of 8.9 million January-March deliveries from 2010-2019, we identified 29,799 (0.33%) readmissions through 9 months for suicide attempt, non-fatal overdose and/or a primary MHC/SUD diagnosis (Figure). Women with an MHC [adjusted odds ratio (aOR) 5.29, 95% confidence interval (CI) (5.04, 5.56)] or SUD [3.96 (3.72, 4.21)] diagnosis had increased odds of mental health readmission (Table). Over 66% of women who were readmitted for a mental health indication had Medicaid at delivery. Of women with Medicaid at delivery and a late (2-to-9 month) postpartum readmission, 25% experienced an interruption to Medicaid coverage. In this group, fragmented Medicaid insurance was associated with increased risk for suicide attempt [1.25 (1.03, 1.52)]. The majority of women who will be readmitted for a mental health indication postpartum have Medicaid at delivery. Fragmentated Medicaid coverage in the postpartum period may disrupt access to behavioral health screening and treatment and is associated with modestly increased risk for suicide attempt.View Large Image Figure ViewerDownload Hi-res image Download (PPT)