Association of Continuous Medicaid Eligibility With Postpartum Coverage and Opioid Use Disorder Treatment.

Publication date: May 29, 2026

Over three quarters of pregnant people with opioid use disorder are enrolled in Medicaid at delivery, but pregnancy-related Medicaid eligibility has historically ended 60 days postpartum, leading to periods without insurance and decreased access to health care during the first year postpartum. The Families First Coronavirus Response Act, passed in March 2020, prevented states from disenrolling Medicaid enrollees, including postpartum enrollees, during the COVID-19 Public Health Emergency. A difference-in-difference model was used to compare the continuity of coverage among postpartum persons with opioid use disorder in Medicaid versus commercial insurance before and after the Families First Coronavirus Response Act . A segmented regression model was used to assess medication for opioid use disorder retention (at 6 and 12 months) among those with Medicaid at delivery before (2016-2019) versus after Families First Coronavirus Response Act (2020-2022). Among deliveries from 2016 to 2022, 1,435 (10. 2%) were enrolled in commercial insurance, and 12,567 (89. 8%) were in Medicaid. In the pre-Families First Coronavirus Response Act period, 60. 0% of commercially insured and 63. 5% of Medicaid-insured deliveries remained enrolled through 12-months postpartum. In adjusted analyses, the Families First Coronavirus Response Act was associated with a 23. 2 percentage-point (95% CI=17. 6%, 28. 8%) increase in 12-month continuous Medicaid coverage compared with that among commercially insured individuals. Among Medicaid enrollees, medication for opioid use disorder retention increased by 14. 4 (95% CI=8. 2, 20. 6) and 16. 3 (95% CI=10. 1, 22. 5) percentage points (level change) in 6- and 12-month medication for opioid use disorder retention, respectively, after the Families First Coronavirus Response Act. In this observational study, the Families First Coronavirus Response Act was associated with increased health insurance stability and improved medication for opioid use disorder retention among postpartum Medicaid beneficiaries with opioid use disorder. These findings suggest that postpartum Medicaid extensions, implemented in 49 states and Washington, DC, could help increase insurance coverage stability and medication for opioid use disorder use for this high-risk population.

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