The effect of continuous postpartum Medicaid coverage on medication for opioid use disorder utilization and Hepatitis C care among people with opioid use disorder
Embargo Date
2027-08-19
OA Version
Citation
Abstract
The rate of pregnant people with opioid use disorder (OUD) diagnosed at delivery increased 131% from 2010 to 2017. The standard of care for pregnant people with OUD is treatment with medications for opioid use disorder (MOUD), yet only half receive treatment. MOUD treatment during and after pregnancy reduces poor maternal and child outcomes, as well as overdoses and maternal mortality. Coinciding with increased opioid use, Hepatitis C virus (HCV) incidence in pregnant people increased 1,458%, from 0.34 to 5.3 cases per 1,000 pregnancies between 1998–2018. For those with OUD and HCV, the postpartum period provides an important opportunity for HCV treatment with direct acting antivirals (DAAs), which can cure HCV.More than 80% of pregnant people with OUD are enrolled in Medicaid, yet over 20% of those with pregnancy-related Medicaid become uninsured within six months postpartum, leading to gaps in postpartum insurance coverage and reduced access to care. The Families First Coronavirus Response Act (FFCRA) continuous enrollment provision prevented states from disenrolling Medicaid beneficiaries, including postpartum beneficiaries, from March 2020–March 2023. Loss of Medicaid coverage among postpartum people consequently decreased during the pandemic, providing a unique opportunity to analyze the effect of extended postpartum coverage on MOUD retention and HCV care.
The overarching goal of this dissertation is to identify how changes to Medicaid policy can improve insurance coverage, MOUD retention, and HCV treatment among postpartum people with OUD and HCV. First, I examined changes in insurance coverage for ≥12 months postpartum pre vs. post-FFCRA among deliveries to people with Medicaid compared to those with commercial insurance (who were unaffected by the continuous enrollment provision). Second, I assessed changes in MOUD retention between the pre- and post-FFCRA periods, and changes in buprenorphine retention among deliveries to people with Medicaid compared to those with commercial insurance pre vs. post-FFCRA. Third, I used a time-to-event analysis to assess when DAA treatment occurs in relation to the 60-day and 1-year postpartum Medicaid coverage cutoffs. Lastly, I assessed changes in linkage to HCV care and DAA treatment initiation after the FFCRA using an interrupted-time-series (ITS) analysis.
Description
2025