Improving Maternal and Child Health in the Year After Birth: An Early Evaluation of Postpartum Medicaid Eligibility Extensions

改善产后一年内的母婴健康：产后医疗补助资格延期的早期评估

• 批准号: 10562733
• 负责人: Lindsay Kennedy Admon
• 金额: $ 40万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10562733
• 关键词: Improving; Maternal; Child; Health; Year

PROJECT SUMMARY State Medicaid programs pay for nearly half of all births in the United States (U.S.), financing over 1.6 million births in 2019. Federal law requires states to provide pregnancy-related Medicaid coverage to low-income pregnant individuals through 60 days postpartum, after which 1 in 4 become uninsured. A substantial and increasing proportion of adverse pregnancy-related outcomes, including maternal morbidity and mortality, are occurring among individuals with Medicaid-paid births and after pregnancy-related Medicaid coverage ends. Postpartum Medicaid eligibility extensions (PMEs) to one year postpartum are an emerging strategy for improving insurance enrollment, healthcare access, and health for low-income mothers and children. Passed in response to the COVID-19 Public Health Emergency, two federal laws have accelerated implementation of PMEs. First, the Families First Coronavirus Response Act (FFCRA) of March 2020 prevented states from disenrolling Medicaid beneficiaries during the public health emergency. In turn, the FFCRA created a national de facto PME. Second, the American Rescue Plan Act (ARPA) of March 2021 allows states to adopt PMEs starting in April 2022 with federal matching funds. Rigorous evaluations of these policies are urgently needed to inform state decisions to adopt PMEs and determine whether these polices are having the intended effect of improving maternal, child, and pregnancy-related health in the year after birth. To inform ongoing, evidence-based policymaking and fill this significant gap in maternal and child health research, our multi-disciplinary team will conduct rigorous, quasi-experimental evaluations that exploit state variation in policy adoption to provide timely data on the FFCRA and ARPA and associated changes in 1) maternal insurance enrollment, healthcare use, and health; 2) children’s insurance enrollment, healthcare use, and health; and 3) outcomes among subsequent pregnancies including rates of short interpregnancy interval and preterm births (NOT-HS-14-004). Given that a disproportionate share of those with Medicaid-paid births and experiencing adverse health events in the postpartum year are low-income and Black, Indigenous, or people of color (AHRQ priority populations), we will also measure the impact of PMEs on racial health equity (NOT-HS-21-014). The proposed set of evaluations will produce data directly informing whether these unprecedented, large-scale policy interventions have been associated with improvements in maternal and child health or racial and ethnic disparities in the year after birth. We will generate timely findings to inform ongoing, evidence-based policymaking to address the U.S. maternal health crisis. Ultimately, we aim to improve health and reduce disparities in the year after birth among low-income mothers and children at the population level.

项目概要 州医疗补助计划为美国 (U.S.) 近一半的新生儿提供医疗费用，资助超过 160 万人 2019 年出生人数。联邦法律要求各州向低收入人群提供与怀孕相关的医疗补助保险 孕妇到产后 60 天，此后四分之一的人没有保险。一个实质性的和 与妊娠相关的不良结局（包括孕产妇发病率和死亡率）所占比例不断增加 发生在医疗补助付费分娩的个人中以及怀孕相关医疗补助覆盖结束后。 将产后医疗补助资格 (PME) 延长至产后一年是一项新兴战略 改善低收入母亲和儿童的保险登记、医疗保健获取和健康状况。通过了 为应对 COVID-19 公共卫生紧急事件，两项联邦法律加快了实施 项目管理专家。首先，2020 年 3 月的《家庭优先冠状病毒应对法案》(FFCRA) 阻止各州 在公共卫生紧急情况期间取消医疗补助受益人的登记。反过来，FFCRA 创建了一个 国家事实上的 PME。其次，2021 年 3 月的《美国救援计划法案》（ARPA）允许各州采用 PME 从 2022 年 4 月开始获得联邦配套资金。迫切需要对这些政策进行严格评估 需要为国家采取 PME 的决定提供信息，并确定这些政策是否达到预期目的 改善出生后一年内孕产妇、儿童和妊娠相关健康的效果。 为正在进行的循证决策提供信息并填补孕产妇和儿童健康方面的巨大差距 研究中，我们的多学科团队将进行严格的、准实验性的评估，利用状态 政策采用的变化，以提供有关 FFCRA 和 ARPA 的及时数据以及 1) 中的相关变化 孕产妇保险登记、医疗保健使用和健康； 2) 儿童保险加入、医疗保健使用、 和健康； 3) 后续妊娠的结果，包括短妊娠间隔率 和早产 (NOT-HS-14-004)。鉴于接受医疗补助生育的人比例不成比例 产后一年中经历不良健康事件的人群是低收入人群、黑人、原住民或 有色人种（AHRQ 优先人群），我们还将衡量 PME 对种族健康公平的影响 （不是-HS-21-014）。 拟议的一组评估将产生数据，直接告知这些前所未有的大规模 政策干预措施与改善孕产妇和儿童健康或种族和民族健康有关 出生后一年内的差异。我们将及时生成调查结果，为正在进行的、基于证据的信息提供信息 解决美国孕产妇健康危机的政策制定。最终，我们的目标是改善健康并减少 低收入母亲和儿童出生后一年在人口层面上的差异。