Public Coverage of Postpartum Services for Immigrants

IMPORTANCE Although 23% of births in the US are to non–US-born birthing parents and 6% of births are to undocumented immigrants, many immigrants have limited access to insurance coverage for postpartum care or contraception, which contributes to substantial health disparities. Understanding policy variation in postpartum coverage for immigrants may lay the groundwork for assessing the association of different policy options with maternal and child health. OBJECTIVE To determine if and how each state provides publicly funded insurance coverage during the postpartum period for immigrant birthing parents. DESIGN, SETTING, AND PARTICIPANTS Policy documentation from every US state and Washington, DC, was reviewed, and legal epidemiology policy mapping via a qualitative content analysis of policy documentation was conducted. Data were collected and analyzed on an ongoing basis between June 2021 and February 2024. MAIN OUTCOMES AND MEASURES For each state, the postpartum funding mechanism for undocumented immigrants and lawful permanent residents were identified, as well as eligibility criteria, services covered, and the duration of eligibility. RESULTS A total of 19 states cover some postpartum care with the Children Health Insurance Program (CHIP) from conception to end of pregnancy option, 30 states use Medicaid or CHIP through the CHIP Reauthorization Act Section 214, and 7 states use state-only funds. There was wide variation within each of these mechanisms regarding financial eligibility, services covered, and duration of coverage. CONCLUSIONS AND RELEVANCE The results of this qualitative study suggest that there is substantial variation between states in whether and how immigrants can access publicly funded health insurance during the postpartum period. Further research is needed to examine the association between state policies and postpartum maternal health outcomes.