Medicaid Reimbursement for Maternal Depression Screening and Care for Postpartum Depression

Abstract

ImportanceClinical guidelines recommend routine screening for postpartum depression (PPD) during well-child visits. All but 5 US states provide Medicaid reimbursement to pediatric practitioners for screening mothers for PPD during well-child visits, but little is known about how reimbursement affects screening, diagnosis, and treatment.ObjectiveTo evaluate the association between Medicaid reimbursement for PPD screening during well-child visits and screening, diagnosis, and treatment for mood or anxiety disorders in the postpartum year.Design, Setting, and ParticipantsThis cohort study used a difference-in-differences study design to analyze claims data and birth records obtained from the Colorado All Payer Claims Database for the period January 1, 2013, to December 31, 2019, for Medicaid-insured and commercially insured births that occurred between 2012 and 2018. Data were analyzed between February 16, 2024, and March 21, 2025.ExposureColorado Medicaid reimbursement for PPD screenings during well-child visits.Main Outcomes and MeasuresThe primary outcome was billed depression screens during well-child visits. Secondary outcomes were diagnoses of a postpartum mood or anxiety disorder and outpatient mental health care or prescription medication use during the postpartum year. We defined an indicator variable for before (2013) vs after (2014-2019) the Colorado Medicaid program began reimbursing for maternal depression screening during well-child visits on January 1, 2014.ResultsThis study included 137 867 births, 104 085 of which were paid by Medicaid and 33 782 of which were paid by commercial insurance. The mean (SD) age of mothers in the Medicaid-insured group during the 2013 prepolicy period was 25.6 (5.7) years compared with 31.7 (4.7) years among mothers in the commercially insured group; during the postpolicy period, the mean (SD) ages were 26.5 (5.7) years and 32.1 (4.4) years, respectively. During the prepolicy period, for births insured by Medicaid vs commercial insurance, the mothers were more likely to have been born outside the US (14.2% vs 10.3%; P = .01), reside in a more rural area (14.5% vs 8.1%; P < .001), have not completed high school or college (24.8% vs 1.1%; P < .001), and have a lower income (80.3% vs 8.2%; P < .001). In adjusted difference-in-differences models, reimbursement for maternal depression screening during well-child visits among Medicaid-insured mothers was associated with a 9.60–percentage point (ppt) (95% CI, 9.10-10.00 ppt) increase in the probability of billed depression screens during well-child visits (P < .001), 0.18 (95% CI, 0.17-0.19) additional billed well-child visit depression screens per birth (ie, 18 additional screens per 100 births), a 2.5-ppt (95% CI, 1.40-3.50 ppt) increase in the probability of being diagnosed with a postpartum mood or anxiety disorder, a 3.3-ppt (95% CI, −4.60 to 2.00 ppt) decrease in prescription medication (P < .001), and a 3.3-ppt (95% CI, 2.50-4.10 ppt) increase in any outpatient mental health treatment (P < .001) compared with mothers who had commercial insurance.Conclusions and RelevanceThe findings of this cohort study suggest that Medicaid reimbursement for PPD screening during well-child visits may increase rates of detection, postpartum mood or anxiety disorder diagnoses, and outpatient treatment among mothers in the postpartum year. Insurance reimbursement for PPD screenings during well-child visits appears to be a promising policy strategy; however, additional interventions may be needed to address barriers to conducting screenings and referrals in pediatric settings and accessing postpartum mental health treatment.