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Immigrant Inequities in Uninsurance and Postpartum Medicaid Extension: A Quasi-Experimental Study in New York City, 2016–2021
Journal Title
American Journal of Public Health
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Publication Date
2025-05
Book Title
Publication Volume
115
Publication Issue
5
Publication Begin
732
Publication End
735
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Abstract
Objectives. To determine if de facto postpartum Medicaid extension during the Families First Coronavirus Response Act (FFCRA) reduced immigrant versus US-born inequities in uninsurance. Methods. We assessed self-reported uninsurance at 2 to 6 months postpartum among people with Medicaid-paid births using the New York City Pregnancy Risk Assessment Monitoring System (PRAMS), comparing immigrant and US-born people. We created a pre-FFCRA cohort of 2611 births from 2016 to 2019 and a post-FFCRA implementation cohort of 1197 births from 2020 to 2021. We calculated risk differences using log binomial regression. Results. Self-reported postpartum uninsurance among immigrants decreased from 13.6% to 9.3% after FFCRA (adjusted risk difference = -4.9%; 95% confidence interval = -7.8%, -2.0%). Immigrant versus US-born inequities in postpartum uninsurance decreased except among Hispanic birthing people, among whom 1 in 6 reported they were uninsured during FFCRA, despite continued eligibility. Conclusions. De facto postpartum Medicaid extension decreased immigrant inequities in insurance coverage, but Hispanic immigrants may have been unaware of continued coverage. Public Health Implications. Postpartum Medicaid extension policies that are inclusive of all immigrants may decrease inequities, but community-integrated implementation is needed to raise awareness of coverage and advance postpartum maternal health equity.
Citation
Janevic T, Birnie L, Belfon K, Glenn L, Maru S, Reynolds S, Eniola F, Kim H, Howell FM, Fox A, Weber E. Immigrant Inequities in Uninsurance and Postpartum Medicaid Extension: A Quasi-Experimental Study in New York City, 2016-2021. Am J Public Health. 2025 May;115(5):732-735. doi: 10.2105/AJPH.2024.307968. Epub 2025 Feb 27. PMID: 40014829; PMCID: PMC11983063.