Experiences of Mothers Following the Medicaid Postpartum Extension

Importance The American Rescue Plan Act of 2021 extended postpartum coverage for women eligible for Medicaid for Pregnant Women from 60 days to 12 months. Understanding how mothers experienced the postpartum extension is vital in evaluating this policy change and informing policymakers on how policies aimed at one family member can improve outcomes for the family unit. Objective To describe the experiences of postpartum mothers following the Medicaid postpartum coverage extension in North Carolina from 60 days to 12 months. Design, Setting, and Participants This qualitative study used semistructured interviews of postpartum mothers conducted between April and October 2025 who delivered while enrolled in Medicaid for Pregnant Women in North Carolina. Transcripts were analyzed using thematic analysis. Main Outcomes and Measures Themes regarding participant experiences with extended postpartum Medicaid coverage. Results A total of 16 mothers (mean [SD] age, 30.0 [5.6] years; mean [SD] number of living children, 3 [1.6]; mean [SD] age of most recent child, 17.0 [4.8] months) participated. Five themes were identified: (1) confusion around Medicaid coverage, (2) Medicaid facilitates care access, (3) behavioral health services as critical during postpartum period, (4) decreased financial stress and improved family interactions, and (5) Medicaid prevents foregone care. Conclusions and Relevance In this qualitative study of postpartum mothers’ experiences accessing care following the Medicaid postpartum coverage extension, when mothers were aware of the extension, coverage was crucial to meet a variety of postpartum needs, especially behavioral health needs, and had positive effects on the entire family. Increasing engagement with Medicaid beneficiaries and community partners about policy changes is critical for increasing effectiveness. Access to behavioral health services is especially important beyond 12 months post partum.