Postpartum Access to Health Care and Opioid Use Treatment: An Evaluation of a Medicaid Population.

Abstract

In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy. We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used. Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively). Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up. Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.