What Does the Recent Literature Say About Medicaid Expansion?: Impacts on Sexual and Reproductive Health
Issue Brief
KFF analysis of 2021 American Community Survey (ACS).
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Jean Guglielminotti, Ruth Landau, and Guohua Li, "The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations," Anesthesia & Analgesia 133 no. 2 (August 2021): 340-348, https://doi.org/10.1213/ANE.0000000000005371
Claire E. Margerison, Katlyn Hettinger, Robert Kaestner, Sidra Goldman-Mellor, and Danielle Gartner, "Medicaid Expansion Associated with Some Improvements in Perinatal Mental Health," Health Affairs 40 no. 10 (October 2021), https://doi.org/10.1377/hlthaff.2021.00776
Bradley Corallo and Brittni Frederiksen, How Does the ACA Expansion Affect Medicaid Coverage Before and During Pregnancy? (Washington, DC: KFF, October 2022), https://www.kff.org/medicaid/issue-brief/how-does-the-aca-expansion-affect-medicaid-coverage-before-and-during-pregnancy/
Lindsey Rose Bullinger, Kosali Simon, and Brownsyne Tucker Edmonds, "Coverage Effects of the ACA's Medicaid Expansion on Adult Reproductive-Aged Women, Postpartum Mothers, and Mothers with Older Children," Maternal and Child Health Journal 26 (March 2022): 1104-1114, https://doi.org/10.1007/s10995-022-03384-8
Maria Steenland, Ira Wilson, and Kristen Matteson, "Association of Medicaid Expansion in Arkansas With Postpartum Coverage, Outpatient Care, and Racial Disparities," JAMA Health Forum 2 no. 12 (December 2021), https://doi.org/10.1001/jamahealthforum.2021.4167
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Bradley Corallo, Jennifer Tolbert, Heather Saunders, and Brittni Frederiksen, Medicaid Enrollment Patterns During the Postpartum Year (Washington, DC: KFF, July 2022), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-patterns-during-the-postpartum-year/
Susannah E. Gibbs and S. Marie Harvey, "Postabortion Medicaid Enrollment and the Affordable Care Act Medicaid Expansion in Oregon," Journal of Women's Health 31 no. 1 (January 2022): 55-62, https://doi.org/10.1089/jwh.2020.8941
Claire E. Margerison, Katlyn Hettinger, Robert Kaestner, Sidra Goldman-Mellor, and Danielle Gartner, "Medicaid Expansion Associated with Some Improvements in Perinatal Mental Health," Health Affairs 40 no. 10 (October 2021), https://doi.org/10.1377/hlthaff.2021.00776
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Summer Hawkins, Krisztina Horvath, Alice Noble, and Christopher Baum, "ACA and Medicaid Expansion Increased Breast Pump Claims and Breastfeeding for Women with Public and Private Insurance," Women's Health Issues 32 no. 2 (March 2022): 114-121, https://www.whijournal.com/article/S1049-3867(21)00158-4/fulltext
Ian Everitt et al., "Association of State Medicaid Expansion Status With Hypertensive Disorders of Pregnancy in a Singleton First Live Birth," Circulation: Cardiovasucular Quality and Outcomes 15 no. 1 (January 2022), https://doi.org/10.1161/CIRCOUTCOMES.121.008249
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Maria Steenland, Ira Wilson, and Kristen Matteson, "Association of Medicaid Expansion in Arkansas With Postpartum Coverage, Outpatient Care, and Racial Disparities," JAMA Health Forum 2 no. 12 (December 2021), https://doi.org/10.1001/jamahealthforum.2021.4167
Sugy Choi et al., "Estimating The Impact on Initiating Medications for Opioid Use Disorder of State Policies Expanding Medicaid and Prohibiting Substance Use During Pregnancy," Drug and Alcohol Dependence 129 pt. A (December 2021), https://www.sciencedirect.com/science/article/abs/pii/S0376871621006578
Maria Steenland and Amal Trivedi, "Association of Medicaid Expansion With Postpartum Depression Treatment in Arkansas," JAMA Health Forum 4 no. 2 (February 2023), https://doi.org/10.1001/jamahealthforum.2022.5603
Pinka Chatterji, Hanna Glenn, Sara Markowitz, and Jennifer Karas Montez, ACA Medicaid Expansions and Maternal Morbidity (National Bureau of Economic Research, Working Paper No. 30770, December 2022), https://www.nber.org/papers/w30770
Hyunjung Lee and Gopal Singh, "The Differential Impact of the COVID-19 Pandemic on Prenatal Care Utilization Among US Women by Medicaid Expansion and Race and Ethnicity," Journal of Public Health Management and Practice Epub ahead of print (December 2022), https://doi.org/10.1097/PHH.0000000000001698
Gabriela Weigel, Brittni Frederiksen, Usha Ranji, and Alina Salganicoff, "Screening and Intervention for Psychosocial Needs by U.S. Obstetrician-Gynecologists," Journal of Women's Health 31 no. 6 (June 2022): 887-894, https://doi.org/10.1089/jwh.2021.0236
However, this study found no significant impact of expansion on the likelihood that OB-GYN practices report actually screening all patients for these needs.
Pinka Chatterji, Chun-Yu Ho, and Xue Wu, Obstetric Unit Closures and Racial/Ethnic Disparity in Health (National Bureau of Economic Research, Working Paper No. 30986, February 2023), https://www.nber.org/papers/w30986
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Claire Margerison, Robert Kaestner, Jiajia Chen, and Colleen MacCallum-Bridgers, "Impacts of Medicaid Expansion Before Conception on Prepregnancy Health, Pregnancy Health, and Outcomes," American Journal of Epidemiology 190 no. 8 (August 2021): 1488-1498, https://doi.org/10.1093/aje/kwaa289
Maria Steenland, Ira Wilson, and Kristen Matteson, "Association of Medicaid Expansion in Arkansas With Postpartum Coverage, Outpatient Care, and Racial Disparities," JAMA Health Forum 2 no. 12 (December 2021), https://doi.org/10.1001/jamahealthforum.2021.4167
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Gabriela Weigel, Brittni Frederiksen, Usha Ranji, and Alina Salganicoff, "Screening and Intervention for Psychosocial Needs by U.S. Obstetrician-Gynecologists," Journal of Women's Health 31 no. 6 (June 2022): 887-894, https://doi.org/10.1089/jwh.2021.0236
Caitlin Carroll, Julia Interrante, Jamie Daw, and Katy Backes Kozhimannil, "Association Between Medicaid Expansion and Closure of Hospital-Based Obstetric Services," Health Affairs 41 no. 4 (April 2022), https://doi.org/10.1377/hlthaff.2021.01478
Jean Guglielminotti, Ruth Landau, and Guohua Li, "The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations," Anesthesia & Analgesia 133 no. 2 (August 2021): 340-348, https://doi.org/10.1213/ANE.0000000000005371
Joanne Constantin and George Wehby, "Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity," American Journal of Preventive Medicine 64 no. 3 (March 2023): 377-384, https://www.ajpmonline.org/article/S0749-3797(22)00498-6/fulltext
Claire E. Margerison, Katlyn Hettinger, Robert Kaestner, Sidra Goldman-Mellor, and Danielle Gartner, "Medicaid Expansion Associated with Some Improvements in Perinatal Mental Health," Health Affairs 40 no. 10 (October 2021), https://doi.org/10.1377/hlthaff.2021.00776
Ian Everitt et al., "Association of State Medicaid Expansion Status With Hypertensive Disorders of Pregnancy in a Singleton First Live Birth," Circulation: Cardiovasucular Quality and Outcomes 15 no. 1 (January 2022), https://doi.org/10.1161/CIRCOUTCOMES.121.008249
Maria Steenland and Laura Wherry, "Medicaid Expansion Led To Reductions In Postpartum Hospitalizations," Health Affairs 42 no. 1 (January 2023): 18-25, https://doi.org/10.1377/hlthaff.2022.00819
Claire E. Margerison, Katlyn Hettinger, Robert Kaestner, Sidra Goldman-Mellor, and Danielle Gartner, "Medicaid Expansion Associated with Some Improvements in Perinatal Mental Health," Health Affairs 40 no. 10 (October 2021), https://doi.org/10.1377/hlthaff.2021.00776
Jean Guglielminotti, Ruth Landau, and Guohua Li, "The 2014 New York State Medicaid Expansion and Severe Maternal Morbidity During Delivery Hospitalizations," Anesthesia & Analgesia 133 no. 2 (August 2021): 340-348, https://doi.org/10.1213/ANE.0000000000005371
In contrast, a national study (Chatterji et al. 2022), cited below, found no significant impact on severe maternal morbidity, but did not limit this analysis by income.
Joanne Constantin and George Wehby, "Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity," American Journal of Preventive Medicine 64 no. 3 (March 2023): 377-384, https://www.ajpmonline.org/article/S0749-3797(22)00498-6/fulltext
Jessian Munoz, "Preterm Birth and Foetal-Neonatal Death Rates Associated With the Affordable Care Act Medicaid Expansion (2014–19)," Journal of Public Health 45 no. 1 (March 2023): 99–101, https://doi.org/10.1093/pubmed/fdab377
Ian Everitt et al., "Association of State Medicaid Expansion Status With Hypertensive Disorders of Pregnancy in a Singleton First Live Birth," Circulation: Cardiovasucular Quality and Outcomes 15 no. 1 (January 2022), https://doi.org/10.1161/CIRCOUTCOMES.121.008249
Pinka Chatterji, Chun-Yu Ho, and Xue Wu, Obstetric Unit Closures and Racial/Ethnic Disparity in Health (National Bureau of Economic Research, Working Paper No. 30986, February 2023), https://www.nber.org/papers/w30986
Joanne Constantin and George Wehby, "Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity," American Journal of Preventive Medicine 64 no. 3 (March 2023): 377-384, https://www.ajpmonline.org/article/S0749-3797(22)00498-6/fulltext
Claire E. Margerison, Katlyn Hettinger, Robert Kaestner, Sidra Goldman-Mellor, and Danielle Gartner, "Medicaid Expansion Associated with Some Improvements in Perinatal Mental Health," Health Affairs 40 no. 10 (October 2021), https://doi.org/10.1377/hlthaff.2021.00776
Ian Everitt et al., "Association of State Medicaid Expansion Status With Hypertensive Disorders of Pregnancy in a Singleton First Live Birth," Circulation: Cardiovasucular Quality and Outcomes 15 no. 1 (January 2022), https://doi.org/10.1161/CIRCOUTCOMES.121.008249
Claire Margerison, Robert Kaestner, Jiajia Chen, and Colleen MacCallum-Bridgers, "Impacts of Medicaid Expansion Before Conception on Prepregnancy Health, Pregnancy Health, and Outcomes," American Journal of Epidemiology 190 no. 8 (August 2021): 1488-1498, https://doi.org/10.1093/aje/kwaa289
Anna Austin, Rebeccah Sokol, and Caroline Rowland, "Medicaid Expansion and Postpartum Depressive Symptoms: Evidence From the 2009-2018 Pregnancy Risk Assessment Monitoring System Survey," Annals of Epidemiology 68 (April 2022): 9-15, https://www.sciencedirect.com/science/article/abs/pii/S1047279721003537
Maria Steenland and Laura Wherry, "Medicaid Expansion Led To Reductions In Postpartum Hospitalizations," Health Affairs 42 no. 1 (January 2023): 18-25, https://doi.org/10.1377/hlthaff.2022.00819
Pinka Chatterji, Hanna Glenn, Sara Markowitz, and Jennifer Karas Montez, ACA Medicaid Expansions and Maternal Morbidity (National Bureau of Economic Research, Working Paper No. 30770, December 2022), https://www.nber.org/papers/w30770
Lydia Pace, Indrani Saran, and Summer Sherburne Hawkins, "Impact of Medicaid Eligibility Changes on Long-acting Reversible Contraception Use in Massachusetts and Maine," Medical Care 60 no. 2 (February 2022): 119-124, https://doi.org/10.1097/MLR.0000000000001666
Erica L. Eliason, Amanda Spishak-Thomas, and Maria W. Steenland, "Association of the Affordable Care Act Medicaid Expansions with Postpartum Contraceptive Use and Early Postpartum Pregnancy," Contraception 113 (September 2022): 42-48, https://www.contraceptionjournal.org/article/S0010-7824(22)00060-9/fulltext
Greta Kilmer et al., "Medicaid Expansion and Contraceptive Use Among Female High-School Students," American Journal of Preventive Medicine 63 no. 4 (October 2022): 592-602, https://www.ajpmonline.org/article/S0749-3797(22)00244-6/fulltext
Mandar Bodas et al., "Association of Primary Care Physicians' Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries," JAMA Health Forum 4 no. 3 (March 2023), https://doi.org/10.1001/jamahealthforum.2023.0106
Susannah E. Gibbs, S. Marie Harvey, Annie Larson, Jangho Yoon, and Jeff Luck, "Contraceptive Services After Medicaid Expansion in a State with a Medicaid Family Planning Waiver Program," Journal of Women's Health 30 no. 5 (May 2021): 750-757, https://doi.org/10.1089/jwh.2020.8351
Mandana Masoumirad, S. Marie Harvey, Linh N. Bui, and Jangho Yoon, "Use of Sexual and Reproductive Health Services Among Women Living in Rural and Urban Oregon: Impact of the Affordable Care Act Medicaid Expansion," Journal of Women's Health 32 no. 3 (March 2023): 300-310, https://doi.org/10.1089/jwh.2022.0308
Lydia Pace, Indrani Saran, and Summer Sherburne Hawkins, "Impact of Medicaid Eligibility Changes on Long-acting Reversible Contraception Use in Massachusetts and Maine," Medical Care 60 no. 2 (February 2022): 119-124, https://doi.org/10.1097/MLR.0000000000001666
Erica L. Eliason, Amanda Spishak-Thomas, and Maria W. Steenland, "Association of the Affordable Care Act Medicaid Expansions with Postpartum Contraceptive Use and Early Postpartum Pregnancy," Contraception 113 (September 2022): 42-48, https://www.contraceptionjournal.org/article/S0010-7824(22)00060-9/fulltext
Greta Kilmer et al., "Medicaid Expansion and Contraceptive Use Among Female High-School Students," American Journal of Preventive Medicine 63 no. 4 (October 2022): 592-602, https://www.ajpmonline.org/article/S0749-3797(22)00244-6/fulltext
Mandar Bodas et al., "Association of Primary Care Physicians' Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries," JAMA Health Forum 4 no. 3 (March 2023), https://doi.org/10.1001/jamahealthforum.2023.0106
Erica L. Eliason, Amanda Spishak-Thomas, and Maria W. Steenland, "Association of the Affordable Care Act Medicaid Expansions with Postpartum Contraceptive Use and Early Postpartum Pregnancy," Contraception 113 (September 2022): 42-48, https://www.contraceptionjournal.org/article/S0010-7824(22)00060-9/fulltext
Susannah E. Gibbs, S. Marie Harvey, Annie Larson, Jangho Yoon, and Jeff Luck, "Contraceptive Services After Medicaid Expansion in a State with a Medicaid Family Planning Waiver Program," Journal of Women's Health 30 no. 5 (May 2021): 750-757, https://doi.org/10.1089/jwh.2020.8351
Mandana Masoumirad, S. Marie Harvey, Linh N. Bui, and Jangho Yoon, "Use of Sexual and Reproductive Health Services Among Women Living in Rural and Urban Oregon: Impact of the Affordable Care Act Medicaid Expansion," Journal of Women's Health 32 no. 3 (March 2023): 300-310, https://doi.org/10.1089/jwh.2022.0308
Greta Kilmer et al., "Medicaid Expansion and Contraceptive Use Among Female High-School Students," American Journal of Preventive Medicine 63 no. 4 (October 2022): 592-602, https://www.ajpmonline.org/article/S0749-3797(22)00244-6/fulltext
Erica Eliason, Jamie Daw, and Heidi Allen, "Association of Medicaid vs Marketplace Eligibility With Maternal Coverage and Access to Prenatal and Postpartum Care," JAMA Network Open 4 no. 12 (December 2021), https://doi.org/10.1001/jamanetworkopen.2021.37383
Mandar Bodas et al., "Association of Primary Care Physicians' Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries," JAMA Health Forum 4 no. 3 (March 2023), https://doi.org/10.1001/jamahealthforum.2023.0106
Erica L. Eliason, Jamie R. Daw, and Heidi L. Allen, "Association of Affordable Care Act Medicaid Expansions with Births Among Low-Income Women of Reproductive Age," Journal of Women's Health 31 no. 7 (July 2022): 949-956, https://doi.org/10.1089/jwh.2021.0451
Kriya S. Patel, Juliana Bakk, Meredith Pensak, Emily DeFranco, "Influence of Medicaid Expansion on Short Interpregnancy Interval Rates in the United States," American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine 3 no. 6 (November 2021), https://www.ajogmfm.org/article/S2589-9333(21)00179-8/fulltext
Erica L. Eliason, Amanda Spishak-Thomas, and Maria W. Steenland, "Association of the Affordable Care Act Medicaid Expansions with Postpartum Contraceptive Use and Early Postpartum Pregnancy," Contraception 113 (September 2022): 42-48, https://www.contraceptionjournal.org/article/S0010-7824(22)00060-9/fulltext
Danielle Gartner, Robert Kaestner, and Claire Margerison, "Impacts of the Affordable Care Act’s Medicaid Expansion on Live Births," Epidemiology 33 no. 3 (May 2022): 406-414, https://doi.org/10.1097/EDE.0000000000001462
Can Liu et al., "Impact of Medicaid Expansion on Interpregnancy Interval," Womens Health Issues 32 no. 3 (May 2022): 226-234, https://www.whijournal.com/article/S1049-3867(21)00190-0/fulltext
Consistent with prior analysis, note that study findings on screening and outcomes related to HPV, as well as gynecological cancer generally, are included in our discussion of research on the impact of expansion on cancer-related outcomes.
Suhang Song and James Kucik, "Trends in the Impact of Medicaid Expansion on the Use of Clinical Preventive Services," American Journal of Preventive Medicine 62 no. 5 (May 2022): 752-762, https://www.ajpmonline.org/article/S0749-3797(21)00595-X/fulltext
Toni Romero and Branco Ponomariov, "The Effect of Medicaid Expansion on Access to Healthcare, Health Behaviors and Health Outcomes Between Expansion and Non-Expansion States," Evaluation and Program Planning Epub ahead of print (May 2023), https://doi.org/10.1016/j.evalprogplan.2023.102304
Andrew Edmonds et al., "Impacts of Medicaid Expansion on Health Insurance and Coverage Transitions among Women with or at Risk for HIV in the United States," Womens Health Issues 32 no. 5 (September-October 2022): 450-460, https://www.whijournal.com/article/S1049-3867(22)00027-5/fulltext
Pedro Botti Carneiro et al., "Demographic, Clinical Guideline Criteria, Medicaid Expansion and State of Residency: a Multilevel Analysis of PrEP Use on a Large US Sample," BMJ Open 12 no. 2 (February 2022), https://bmjopen.bmj.com/content/12/2/e055487.info
Bita Fayaz Farkhad, Mohammadreza Nazari, Man-pui Sally Chan, and Dolores Albarracín, "State Health Policies and Interest in PrEP: Evidence from Google Trends," AIDS Care 34 no. 3 (2022): 331-339, https://doi.org/10.1080/09540121.2021.1934381
J. Logan et al., "HIV Care Outcomes in Relation to Racial Redlining and Structural Factors Affecting Medical Care Access Among Black and White Persons with Diagnosed HIV—United States, 2017," AIDS and Behavior 26 (March 2022): 2941–2953, https://doi.org/10.1007/s10461-022-03641-5
The Hyde amendment includes exceptions for pregnancies that are the result of rape, incest, or if the pregnant person’s life is in danger.
In particular, the abortion analysis was not restricted to women with Medicaid-eligible incomes and was not limited to only states that cover abortions in Medicaid.
Erica L. Eliason, Jamie R. Daw, and Heidi L. Allen, "Association of Affordable Care Act Medicaid Expansions with Births Among Low-Income Women of Reproductive Age," Journal of Women's Health 31 no. 7 (July 2022): 949-956, https://doi.org/10.1089/jwh.2021.0451
Samuel Mann et al., "Effects of the Affordable Care Act's Medicaid Expansion on Health Insurance Coverage for Individuals in Same-sex Couples," Health Services Research 58 no. 3 (June 2023): 612-621, https://doi.org/10.1111/1475-6773.14128
Nguyen Tran, Kellan Baker, Elle Lett, and Ayden Scheim, "State-Level Heterogeneity in Associations Between Structural Stigma and Individual Health Care Access: A Multilevel Analysis of Transgender Adults in the United States," Journal of Health Services Research & Policy 28 no. 2 (April 2023): 109-118, https://doi.org/10.1177/13558196221123413