Continuous Medicaid Coverage for Pregnant Patients and Its Impact on OUD Treatment
Extending Medicaid postpartum coverage is associated with expanding coverage and improving opioid use disorder treatment retention for pregnant patients.
Medications for opioid use disorder (MOUD) are the gold standard of care to treat opioid use disorder among pregnant patients. Medicaid, which covers nearly 8 in 10 pregnant women with OUD in the U.S., is a critical resource for this population to access and afford MOUD before and after childbirth. Two major legislations passed in response to the COVID-19 pandemic changed how Medicaid covered pregnant patients and prompted a new study by Breanne Biondi, postdoctoral scholar at the University of Chicago and 2024-2025 CHERISH pilot grant recipient.
Breanne Biondi, PhD
Breanne Biondi received a CHERISH pilot grant in 2024 to support her one-year pilot project examining postpartum Medicaid coverage among people with OUD. At the time, Biondi was a PhD candidate in health services and policy research at the Boston University School of Public Health.
The Family First Coronavirus Response Act (FFCRA), signed in March 2020, prevented states from disenrolling Medicaid beneficiaries, including postpartum patients, during the COVID-19 Public Health Emergency. The following year, under the American Rescue Plan Act (ARP), most states extended the pregnancy-related Medicaid coverage period from 60 days to 1 year postpartum without interruptions. Through ARP, new moms no longer lose coverage 60 days after giving birth and can receive continuous postpartum care including MOUD. However, because of other COVID-19 policies and varied implementation dates, it is challenging to evaluate the direct effects of the postpartum extensions passed under ARP.
In this study, FFCRA serves as the proxy for ARP because the uninterrupted Medicaid coverage under FFCRA is comparable to an extension of postpartum coverage. To understand the impact on people with OUD of extending pregnancy-related Medicaid benefits, Biondi conducted a difference-in-difference analysis to compare the continuity of coverage and MOUD retention rates among those insured by Medicaid and commercial insurance before and after FFCRA. Biondi and co-authors used data from TriNetX Linked to identify more than 14,000 deliveries among 12,700 people with OUD between 2016 and 2022.
Key Findings
Published in the American Journal of Preventive Medicine, findings demonstrate that the FFCRA extension was associated with substantial increases in continuous Medicaid coverage and improved MOUD retention among postpartum patients with OUD.
- Between 2016-2018, prior to FFCRA, nearly 64% of Medicaid-insured deliveries remained covered through 12 months postpartum, which increased to 88% between 2020-2022, after the FFCRA.
- In states that did not expand Medicaid, there were even larger increases in postpartum coverage (38 percentage-point increase).
- After the FFCRA, between 2020-2022, MOUD retention among Medicaid enrollees increased by 14 and 16 percentage points for 6- and 12-month medication retention respectively compared the end of 2018.
Ahead of the proposed Medicaid changes that may result in coverage loss, this study offers new evidence to support the extension of pregnancy-related Medicaid benefits to reduce gaps in healthcare coverage for postpartum patients with OUD. Arkansas, a state that has one of the highest maternal mortality rates in the country, is the only state that has not yet extended pregnancy-related Medicaid coverage as of 2026. The risk of overdose for this population is highest between 7-12 months after childbirth, marking the 1-year postpartum window as a critical period to provide new moms with stable health insurance coverage and access to affordable MOUD.
The study, “Association of continuous Medicaid eligibility with postpartum coverage and opioid use disorder treatment,” was published in the American Journal of Preventive Medicine on May 28, 2026, and partly supported by a CHERISH pilot grant awarded to Breanne Biondi in 2024. The manuscript also features senior author and CHERISH Research Affiliate Rachel Epstein.