HLTH 349 Week 4 Article Review 2 Example

A Year of Coverage After Birth: A Review of North Carolina's Experience Extending Postpartum Medicaid

Introduction

For decades, women whose Medicaid eligibility rested on being pregnant were dropped from the program 60 days after delivery, even though many still had health problems that needed attention. In many states, a new mother earning slightly above the poverty line had no affordable coverage once those two months ended. Swartz et al. (2025) examined what happened when North Carolina extended coverage to a full year, a change many states adopted after federal law allowed it in 2021.

Summary

The authors used Medicaid claims for 353,957 births in North Carolina from 2017 through 2022 and compared three periods: before the COVID-19 public health emergency, during the emergency when states could not remove people from Medicaid and after the state adopted the twelve-month extension. Before the emergency, only 26.5% of these mothers still had full Medicaid a year after giving birth; under the extension, 97.1% did. Use of care rose with it: primary care visits increased from 25.3% to 71.4% of mothers, outpatient mental health care from 7.5% to 25.7% and contraceptive visits from 38.0% to 47.9%. The authors also noted some delays in early postpartum and contraceptive visits.

Discussion

McKenzie et al. (2018) describe maternal, infant and child health as a foundation of community health, because the well-being of mothers shapes the health of children and families. They also emphasize that access to care before, during and after pregnancy reduces complications. The article shows how much access depends on coverage. Before the extension, most mothers lost Medicaid at a time when conditions such as high blood pressure, heart problems and depression can still develop. A mother's health needs do not end at six weeks, and a policy that keeps her insured for a year finally matches coverage to the risks she faces. The large rise in mental health care is especially important, since postpartum depression is common and often untreated, and the rise in substance use treatment matters for a group in which overdose is a leading cause of death during the year after birth. A limitation is that the study describes one state and its comparison of time periods cannot rule out other changes, such as the pandemic's effect on how people sought care. Coverage also does not guarantee equity. Janevic et al. (2026) found that continuous coverage reduced uninsurance among Black postpartum women in states without Medicaid expansion, but gaps between Black and White women remained.

Conclusion

This study suggests that extending postpartum Medicaid gives mothers real access to primary, mental health and substance use care during the year when they need it. Public health agencies can build on the policy by helping mothers schedule early visits, by making sure eligible mothers know their coverage continues and by tracking whether gaps between groups narrow over the coming years.

References

Janevic, T., Kim, H., Ng, A., Howell, F. M., Liu, S. H., Fox, A., & Weber, E. (2026). Racial inequities in postpartum coverage during Medicaid continuous coverage: Evidence from Affordable Care Act expansion versus nonexpansion states. American Journal of Preventive Medicine, 71(1), 108320. https://doi.org/10.1016/j.amepre.2026.108320

McKenzie, J. F., Pinger, R. R., & Seabert, D. M. (2018). An introduction to community & public health (9th ed.). Jones & Bartlett Learning.

Swartz, J. J., Lawson Avis, A., Bundorf, M. K., & Domino, M. E. (2025). Postpartum Medicaid use in birthing parents and access to financed care. JAMA Health Forum, 6(6), e251630. https://doi.org/10.1001/jamahealthforum.2025.1630