{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:26:33Z","timestamp":1781000793554,"version":"3.54.1"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1R01AG075160-01A1"],"award-info":[{"award-number":["1R01AG075160-01A1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Rural residents experience higher rates of postpartum uninsurance than their urban counterparts, contributing to rural\u2013urban disparities in maternal health outcomes. We examined how Medicaid expansion under the Affordable Care Act affected rural\u2013urban disparities in the rates of postpartum health insurance coverage among low-income women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used nationally representative data from the 2010-2012 and 2015-2019 American Community Survey to compare rates of postpartum health insurance coverage among low-income women in states that expanded Medicaid and states that did not expand Medicaid (difference-in-differences analysis). We analyzed changes in disparities in postpartum health insurance coverage between women living in rural areas and women living in urban areas (difference-in-difference-in-differences analysis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Women living in rural areas had the greatest increases in postpartum health insurance coverage, with a 17.0 percentage-point increase in states that expanded Medicaid (95% CI, 13.9-20.2) and an 11.5 percentage-point increase in states that did not expand Medicaid (95% CI, 9.2-13.8). Any postpartum health insurance coverage among rural residents relative to urban residents increased by 4.8 percentage points (95% CI, 2.0-7.7) in states that expanded Medicaid compared with states that did not. We observed similar trends for Medicaid postpartum health insurance coverage specifically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Rural women had greater increases in postpartum health insurance coverage relative to urban women following Medicaid expansion, thereby reducing geographic disparities in health insurance coverage during the postpartum period. Future research should focus on whether disproportionate gains in health insurance coverage for rural communities led to increased access to care during the postpartum period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549251403896","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T07:31:31Z","timestamp":1770190291000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Medicaid Expansion and Rural\u2013Urban Disparities in Postpartum Medicaid Coverage"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2198-4535","authenticated-orcid":false,"given":"Elizabeth","family":"Boggs","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1970-314X","authenticated-orcid":false,"given":"Andrei","family":"Stefanescu","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA"},{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gritz","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA"},{"name":"Adult &amp; Child Center for Outcomes Research &amp; Delivery Science, University of Colorado Anschutz School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rich","family":"Lindrooth","sequence":"additional","affiliation":[{"name":"Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2059-9711","authenticated-orcid":false,"given":"Lindsay","family":"Admon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0610-9707","authenticated-orcid":false,"given":"Renuka","family":"Tipirneni","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA"},{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00805"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005081"},{"key":"e_1_3_2_4_2","unstructured":"Searing A Cohen Ross D. 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