An estimated 12 % of reproductive aged women in the U.S. have a disability.1 Ensuring that people with disabilities have access to perinatal care is important as individuals with disabilities can face unique health needs and barriers to care before, during, and after pregnancy.2 Research has found that pregnant people with disabilities experience greater risk of adverse perinatal conditions, including gestational hypertension, gestational diabetes, and postpartum depression.3,4 Studies have also found lower use of routine pregnancy and reproductive health care services among individuals with disabilities, including a lower likelihood of attending visits for postpartum care and using any contraceptive method postpartum.5,6 Individuals with disabilities report encountering multiple barriers to receiving this care, including accessibility challenges, negative or non-responsive provider interactions, difficulty paying for services, and lack of health insurance coverage.7,8

The COVID-19 public health emergency (PHE) disrupted health care access, leading to delays and avoidance of medical care due to COVID-19 concerns.9 In addition, these care disruptions resulted in declines in postpartum visit attendance during the COVID-19 pandemic.10 Existing research suggests that pandemic-related disruptions in medical care use were significantly larger for adults with disabilities, many of whom require assistance to attend in-person appointments (e.g. interpretation, driver, etc.).11 As a result, pandemic-related care disruptions may have exacerbated existing disparities in postpartum care use between people with and without disabilities.5

To improve care access during the PHE, the Families First Coronavirus Response Act (FFCRA) included a provision that states could not disenroll anyone with Medicaid coverage during the PHE even if their Medicaid eligibility changed. Medicaid is a major health insurance provider for people with disabilities, providing coverage to approximately 44 % of women with disabilities aged 18–64 and more than 60 % of individuals with disabilities who had a recent live birth.5,12 Medicaid coverage is available to adults with household incomes ranging from 0 to 221 % of the federal poverty level based on state eligibility levels and parental status.13 Pregnancy-related Medicaid coverage is available to individuals with higher incomes for the pregnancy duration through 60 days postpartum. In most states, people with certain chronic disabilities (e.g. limited vision or hearing) are automatically eligible for Medicaid through a disability-related Medicaid pathway.14 In addition, in 42 states, people who receive Supplemental Security Insurance (SSI) payments based on a combination of low-income and disability are also eligible for Medicaid coverage.15 Among the non-elderly adults with disabilities who reported Medicaid enrollment in the American Community Survey in 2019, approximately one-third qualified for Medicaid through a disability-related eligibility pathway and two-thirds qualified based on income.16

The FFCRA Medicaid continuous coverage provision increased the number of people enrolled in Medicaid,17 including in the postpartum period as individuals no longer experienced pregnancy-related Medicaid insurance loss after 60 days postpartum.18 As Medicaid is a major insurer of people with disabilities, Medicaid policy changes under the FFCRA could have important implications for Medicaid enrollment and healthcare use among postpartum people with disabilities.5,14 However, little research has focused on changes in perinatal insurance coverage or care for individuals with disabilities during the PHE, for whom access to postpartum and reproductive care is particularly important. Thus, the objective of this study was to examine how postpartum insurance coverage, postpartum visits, and postpartum reproductive health care changes differed for individuals with disabilities during the COVID-19 PHE compared to individuals without disabilities.