Medicaid finances a substantial proportion of births in the United States and plays a central role in shaping postpartum care access among socioeconomically disadvantaged populations. The postpartum period is also associated with elevated risk of depression, anxiety, and substance use disorders; however, engagement with mental health services remains inconsistent. This review critically synthesizes empirical literature on postpartum care attendance and mental health service utilization among Medicaid-enrolled populations, with emphasis on policy context, structural disparities, and care integration. A narrative critical review approach was used to examine studies on postpartum visit attendance, behavioral health service use, and Medicaid policy reforms, including expansion and extended postpartum coverage. The review evaluates how these domains are defined, measured, and analytically linked. The findings indicate that postpartum care attendance remains incomplete and unevenly distributed, with persistent disparities by race, geography, and substance use status. Although Medicaid expansion and 12-month postpartum coverage extensions improve insurance continuity and outpatient utilization, they do not consistently translate into mental health screening, referral, or sustained treatment. Existing literature largely treats postpartum attendance and mental health utilization as separate outcomes, limiting understanding of care progression. This review reframes postpartum care attendance as a mediating step within a multistage care continuum rather than a terminal metric. Policy reforms should prioritize behavioral health integration, continuity-focused quality measures, and equity-driven delivery models. Future research should employ longitudinal and mediation-based designs to assess sustained mental health engagement.
Frimpong et al. (Sat,) studied this question.