The economics of medicaid expansion and maternal-infant health in the United States

Medicaid expansion under the Affordable Care Act is one of the most significant health policy reforms affecting maternal and infant health in the United States. As Medicaid finances a substantial proportion of births and provides coverage for many low-income women before, during, and after pregnancy, eligibility policies have important clinical, economic, and equity implications. This review examines the impact of Medicaid expansion on maternal and infant health, focusing on insurance coverage, healthcare utilization, maternal morbidity and mortality, postpartum health, infant outcomes, financial protection, racial disparities, rural access, and policy sustainability. The review argues that Medicaid expansion generates economic value by shifting care from costly emergency treatment to preventive, continuous, and timely care. It also reduces uncompensated care, protects families from medical debt, and strengthens the financial stability of hospitals and other safety-net providers. However, Medicaid expansion alone is insufficient to eliminate maternal and infant health disparities. Persistent challenges—including low Medicaid reimbursement, maternity care deserts, racial inequities, rural hospital closures, transportation barriers, fragmented postpartum care, and variation in state implementation—continue to limit its impact. This review concludes that expanding Medicaid coverage, preserving 12-month postpartum eligibility, improving provider reimbursement, supporting midwives and doulas, investing in rural maternity care, and strengthening maternal health data systems are essential to improving maternal and infant health outcomes in the United States.