Continuous Medicaid Coverage Policy Reduces Postpartum Uninsurance for Black Women but Fails to Close Racial Gaps

Columbia University research shows continuous Medicaid coverage reduced postpartum uninsurance for Black women, though racial disparities in health access remain.

By: AXL Media

Published: Mar 18, 2026, 9:01 AM EDT

Source: Information for this report was sourced from Columbia University's Mailman School of Public Health

Evaluating the Impact of Federal Policy on Postpartum Health Equity

A new analysis published in the American Journal of Preventive Medicine has provided the first detailed look at how the COVID-19 pandemic's continuous Medicaid coverage provision affected racial equity in postpartum insurance. Researchers at Columbia Mailman School of Public Health found that the policy acted as a natural experiment, demonstrating the potential for extended coverage to reduce uninsurance during the critical 12 months following delivery. While the policy led to a notable decline in uninsurance among Black women in states that had previously resisted Medicaid expansion under the Affordable Care Act, the study highlights a sobering reality: the fundamental gap between Black and White women's access to coverage remained unchanged throughout the study period.

Addressing the High Stakes of the Postpartum Period for Black Mothers

The postpartum period is a phase of intense physiological and psychosocial change that requires consistent medical monitoring to prevent morbidity and mortality. In 2022, data indicated that Black women were twice as likely to experience pregnancy-related death within 42 days of delivery and four times as likely to die within the first year postpartum compared to White women. Dr. Teresa Janevic, an Associate Professor of Epidemiology at Columbia, noted that this period often widens existing health disparities, with Black women facing higher risks of depression, hospital readmissions, and severe complications. The research suggests that while insurance is a vital component of the solution, it cannot serve as the sole mechanism for resolving these deeply rooted inequities.

Significant Gains in Medicaid Coverage Within Non Expansion States

Before the pandemic policy, uninsurance rates were starkly higher in non-expansion states, affecting 16.5% of Black women and 11% of White women in 2019. The federal continuous coverage mandate fundamentally shifted these numbers by 2023, specifically driving down uninsurance among Black women in non-expansion states by five percentage points more than in states that had already expanded Medicaid. This reduction was primarily fueled by an increase in Medicaid enrollment, which rose from 38% in 2019 to a peak of 45% in 2021. These findings underscore the outsized importance of Medicaid for Black families, who are stat...