Expanding comprehensive pregnancy care for Emergency Medicaid recipients: a cost-effectiveness analysis

Background Emergency Medicaid is a restricted benefits program for individuals who are low-income and immigrants Objective We compared the cost-effectiveness of two strategies of pregnancy coverage for Emergency Medicaid recipients: the federal minimum of covering the delivery only vs extended coverage to 60 days postpartum. Study Designs We built a decision-analytic Markov model to evaluate the outcomes and costs of these policies, and applied results to a theoretical cohort of 100,000 postpartum Emergency Medicaid recipients. We adopted the payor perspective. We examined health outcomes and cost-effectiveness over a one- and three-year time horizon. All probabilities, utilities and costs were obtained from the literature. Our primary outcome was the incremental cost effectiveness ratio of the competing strategies. Results Extending Emergency Medicaid to 60 days postpartum is a cost-effective strategy. Providing postpartum and contraceptive care resulted in 33,900 additional people receiving effective contraception in the first year and prevented 7,290 additional unintended pregnancies. Over 1 year; it resulted in a gain of 1,566 quality adjusted life year at a cost of $10,903 per quality adjusted life year. By 3 years of policy change, greater improvements were observed in all outcomes and expansion of Emergency Medicaid became cost-saving and the dominant strategy. Conclusion Inclusion of postpartum care and contraception for immigrant women who are low-income results in lower costs and improved health outcomes.