(432) Examining The Cost-Effectiveness of Post-partum Medicaid Care in People with a History of SMM

Emergency Medicaid is a restricted benefits program that covers immigrants who are pregnant and low-income. 5 States and the District of Columbia have extended postpartum coverage for Emergency Medicaid to 60 days postpartum. We examined the cost-effectiveness of this program among people with a delivery complicated by severe maternal morbidity (SMM).

Study Design:

We designed a cost-effectiveness model using TreeAge to compare outcomes in people with SMM who received post-partum care under extended Emergency Medicaid coverage and those who did not. We used a theoretical cohort of 5,000 as an estimate of the number of SMM cases in the 5 states and DC that have this extension in place. Patients were then stratified by use of postpartum contraception as documented under Medicaid expansion and rates of subsequent pregnancy and SMM were calculated. Our outcomes included unintended pregnancy, repeat cases of SMM, and maternal death in addition to cost and quality-adjusted life years (QALYs). Probabilities, costs, and utilities were derived from the literature, and QALYs generated at a discount rate of 3%. Sensitivity analyses were performed to assess the robustness of our model.

Results:

For a theoretical cohort of 5,000 patients with a history of SMM in a previous pregnancy in an emergency Medicaid eligible population, extended post-partum coverage resulted in 206 fewer unintended pregnancies with 10 fewer repeat cases of SMM. Extended Emergency Medicaid post-partum coverage also resulted in a decreased cost of $2.48 million and increased QALYs by 3 thus making it a dominant cost-effective strategy.

Conclusion:

Extending postpartum coverage for Emergency Medicaid patients with SMM is a dominant cost-effective strategy, resulting in reduced costs and increased quality of life. These results demonstrate the benefits of such an extension and highlight the importance of expanding coverage beyond 5 states.