Evaluating Medicaid Postpartum Coverage Extensions through an Equity Lens

项目摘要 最近关于延长产后医疗补助的政策辩论受到美国产妇健康危机的推动： 美国的孕产妇死亡率是高收入国家中最高的，其中包括明显的种族不平等。黑色 人们死于妊娠相关原因的风险是白人的3倍以上。种族和民族 产妇发病率的差异也同样明显。移民也面临着更高的孕产妇发病率 以及围产期并发症。持续、持续地获得围产期保健对孕产妇健康至关重要 和医疗公平，然而，大约45%的使用医疗补助和芯片的分娩者在60天后失去保险。产后 延长医疗补助是最近旨在解决黑人产妇高得可怜的问题的政策尝试的关键特征 死亡率和发病率。然而，塑造美国机构的结构性种族主义意味着这样的政策可能 缓解或加剧不平等现象。政策制定者需要关于产后医疗补助影响的证据 获得产妇保健公平，以指导设计和实施。 自2020年3月以来，家庭第一冠状病毒应答法(FFCRA)授予了事实上的 医疗补助计划在全国范围内扩大了产后覆盖范围，但它即将到期。与此同时，27个州 已经通过或正在寻求通过立法延长产后医疗补助覆盖范围，但他们的 政策方法在法律基础、资格标准、覆盖范围和移民排除方面各不相同。 此外，在大流行之前，各州在现有的医疗补助资格政策上存在差异，这对 被塑造的人在大流行期间仍然符合资格，但大流行后资格不确定。我们的 总体目标是评估产后医疗补助政策对产妇健康的影响 公平。我们建议使用自适应并发混合方法设计来衡量国家变化 产后医疗补助登记，同时利用两个州政策的差异来检查医疗保健 更深入地利用。我们专注于两个不同的大州：德克萨斯州(德克萨斯州)已将医疗补助扩大到六个 产后几个月通过示范豁免，而纽约(NY)正在使用美国救援计划 采取行动扩大产后12个月的医疗补助计划。使用全国美国社区调查(ACS)和 医疗补助申请数据来自德克萨斯州和纽约州，我们的量化目标将应用中断时间序列(ITS)和 差异法(DID)。在我们的定性目标中，我们将采访产后妇女， 关于产后疗效的医疗保健提供者、社区组织和政策制定者 医疗补助延期实施，这将为分析方法提供信息，并丰富我们的研究结果。 我们的提案不仅填补了关于产后获得医疗补助的影响的有针对性研究的空白 孕产妇健康公平，但也改变了范式，将重点放在结构性种族主义在设计和 政策执行情况及其对孕妇获得产后福利的影响。我们的发现将 成为政策制定者公平设计和实施产后医疗补助延期的关键资源。

Project Summary Recent policy debates to extend Medicaid postpartum are fueled by the US maternal health crisis: The US maternal mortality rate is the highest among high-income countries and includes stark racial inequities. Black people have more than 3X risk of dying from pregnancy related causes than White people. Racial and ethnic disparities for maternal morbidity are equally glaring. Immigrants, too, face higher rates of maternal morbidity and perinatal complications. Sustained, continuous access to perinatal health care is critical to maternal health and health equity, yet ~45% of birthing people with Medicaid and CHIP lose coverage after 60 days. Postpartum Medicaid extensions are key features of recent policy attempts to address the deplorably high Black maternal mortality and morbidity rates. However, structural racism shaping US institutions means such policies could either mitigate or exacerbate inequities. Policymakers need evidence about the impact of postpartum Medicaid access on maternal health equity to guide design and implementation. Since March 2020, the Families First Coronavirus Response Act (FFCRA) has conferred a de-facto Medicaid postpartum coverage extension nationwide, but it is due to expire imminently. Meanwhile, 27 states have already adopted or are seeking to pass legislation to extend postpartum Medicaid coverage, but their policy approaches vary in legal basis, eligibility criteria, length of coverage, and immigrant exclusions. Moreover, states vary in their existing Medicaid eligibility policies prior to the pandemic, which has profoundly shaped who has remained eligible during the pandemic with uncertain eligibility post-pandemic. Our overarching objective is to evaluate the impact of postpartum Medicaid policy on maternal health equity. We propose using an adaptive concurrent mixed-methods design to measure national changes in postpartum Medicaid enrollment while exploiting differences in two states' policies to examine health care utilization in greater depth. We focus on two large, diverse states: Texas (TX) has expanded Medicaid to six months postpartum through a demonstration waiver, while New York (NY) is using the American Rescue Plan Act to expand Medicaid 12 months postpartum. Using national American Community Survey (ACS) and Medicaid claims data from TX and NY, our quantitative aims will apply interrupted time series (ITS) and difference-in-difference (DID) approaches. In our qualitative aim, we will interview postpartum women, healthcare providers, community-based organizations, and policymakers on the efficacy of postpartum Medicaid extension implementation, which will inform the analysis approach and enrich our findings. Our proposal not only fills gaps in targeted research on the impact of postpartum Medicaid access on maternal health equity, but also shifts the paradigm to focus on the role of structural racism in the design and implementation of policy and its influence on pregnant people's access to postpartum benefits. Our findings will be a key resource for policymakers on equitable design and implementation of postpartum Medicaid extension.