Director's Policy Corner

There is a lot happening in the world of women’s health. In this ongoing series, we’re featuring important policy updates affecting women's health services in Oregon and beyond. This edition focuses on the impact of changes to Emergency Medicaid in contraceptive and postpartum coverage.

Federal law does not allow undocumented immigrants or documented immigrants who have been in the United States less than five years access to Medicaid.  People who meet all of the other requirements for Medicaid except citizenship status are restricted to Emergency Medicaid. Emergency Medicaid only covers life-threatening conditions. For women of reproductive age, this includes admission to the hospital for childbirth, but leaves out: 

• Prenatal care
• Care after childbirth 
• Birth control 

Health care during pregnancy - from before conception to a year following birth - is critical for both maternal and newborn health. Immigrants have been systematically excluded from coverage. In 2009, a new federal policy allowed states to provide prenatal care to people with Emergency Medicaid. However, the new policy did not include coverage of after-baby visits and services, including birth control. While the new policy showed improved prenatal screening tests and vaccinations, access to birth control after having a baby remained flat. 

Oregon expands coverage

Oregon passed The Reproductive Health Equity Act, also known as House Bill 3391, in 2017. Among other things, the act expanded after-baby care to include the Emergency Medicaid population. This new coverage also included birth control services.  

How did this change in policy affect birth control use following the birth of a baby in Oregon? To answer this question, researchers compared two states: Oregon and South Carolina. Both had similar growth in their immigrant populations and are about the same size. However, unlike Oregon, South Carolina did not extend coverage beyond the federal minimum. Did these two states see the same outcomes? 

Effects of Emergency Medicaid coverage in Oregon

Researchers looked at a total of 27,667 births (15,465 in Oregon and 12,202 in South Carolina). They reviewed visits up to 60 days after childbirth and compared rates new contraception use during that time window.  

• Before the change in policy in Oregon, 8.8% of Emergency Medicaid patients had a visit following the birth of their baby. After the act went into effect that number jumped to more than half of the women. 
• In comparing the two states, there was more than a 40% increase in visits in Oregon in comparison to South Carolina. 
• Similarly, only 9.4% of Emergency Medicaid recipients had a birth control method by 60 days postpartum before the policy change. This contrasts sharply with their citizen peers; 35% were using birth control by 60 days postpartum. After the policy change,  more than 4 in 10 received birth control within the 60 day window . This represents nearly a one-third increase in Oregon. 
• Researchers also noted jumps in tubal ligation and long-acting removable contraception (LARC) options.