Racial Inequities in Postpartum Coverage During Medicaid Continuous Coverage: Evidence from ACA Expansion vs Non-Expansion States

Black women in the United States (US) experience persistently high rates of maternal morbidity and mortality. In 2022, Black women had two times the rate of pregnancy-related death within 42 days of delivery than non-Hispanic White women1, and were more than four times more likely to die of pregnancy-associated deaths up to 12 months postpartum.2 Maternal death, however, is only the tip of the iceberg, with increasing evidence that the postpartum period exacerbates racial health inequities more broadly. For example, in the postpartum period, Black women have elevated rates of severe maternal morbidity,3 postpartum depression,4 hospital readmissions and Emergency Department visits,5 all of which are associated with poorer access to health care.