Impact of Medicaid Postpartum Coverage Extension and Mandated Postpartum Depression Screening on Care for Gestational Diabetes and Pregnancy-Induced Hypertension

摘要 妊娠期糖尿病(GDM)和妊娠高血压综合征(PIH)都会影响怀孕、生育 结果，以及产后护理。它们是糖尿病(T2 DM)、高血压的独立危险因素 (HTN)和精神健康状况，如产后抑郁症(PPD)。尽管有建议说 产后护理应包括血压(BP)、血糖(BG)监测和产后抑郁筛查， 目前的产后护理做法筛查率很低，特别是在医疗补助受益人中。而当 医疗补助覆盖美国近一半分娩，许多分娩者60天内失去保险 出生后。《2021年美国救援计划法案》为各州提供了延长产后时间的联邦资金 覆盖范围长达12个月-路易斯安那州已经这样做了，而密西西比州还没有。另外，在2022年8月1日， 路易斯安那州颁布了一项全州范围的强制令，要求产后护理提供者筛查产后抑郁和相关 精神健康障碍。利用我们与全国生育公平协会的合作和结合 专业知识，我们建议评估医疗补助产后延长(MPE)和PPD筛查的效果 路易斯安那州(LA)关于筛查行为、健康结果和患者体验的规定与 密西西比州(MS)分三个时期(2022年初至2023年、2024年中期至2025年和2026年末至2027年)。我们将链接 路易斯安那州和密西西比州的电子健康记录和医疗补助索赔数据，使我们能够跟踪筛查 以及即使在分娩后失去医疗补助覆盖范围的后续护理。主要有效性衡量标准将是 作为3个月BP、BG和PPD的综合筛查率。次要措施包括个人 T2 DM、HTN和PPD的筛查率、诊断和处理。理解这一点也很重要 造成产后护理差异的环境因素和健康不平等，并估计 这些政策的成本效益。总体目标是评价有效的执行战略，目的是 改善患有妊娠期糖尿病或妊高征的医疗补助受益人的产妇产后健康。为了实现这一目标， 研究将有三个具体目标。首先，我们将检查路易斯安那州MPE和PPD的有效性 BG和BP监测、PPD筛查、T2 DM、HTN和PPD的筛查任务 诊断、T2 DM、HTN和PPD管理、健康差距和卫生保健利用，与 密西西比州的同行。第二个目标将是审查成本效益和分配成本- 路易斯安那州MPE和PPD筛查任务的有效性来自患者、提供者、付款人和社会 透视。第三个目标将是考察影响收养和 实施MPE和PPD筛查任务，以及对医疗保健提供和医疗保健的后续影响 路易斯安那州和密西西比州内和密西西比州之间的利用率和孕产妇保健公平。调查结果将告知 同时和未来的卫生政策战略，以告知、参与和增强生育人员 改善美国的孕产妇健康状况，消除孕产妇健康差距。

Abstract Both gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) affect pregnancy, birth outcomes, and postpartum care. They are independent risk factors for diabetes mellitus (T2DM), hypertension (HTN), and mental health conditions such as postpartum depression (PPD). Despite recommendations that postpartum care should include blood pressure (BP), blood glucose (BG) monitoring, and PPD screening, current postpartum care practices have low screening rates, especially among Medicaid beneficiaries. While Medicaid covers nearly half of deliveries in the United States, many birthing people lose coverage 60 days after birth. The American Rescue Plan Act of 2021 provided states with federal funding to extend postpartum coverage up to 12 months – Louisiana has done so while Mississippi has not. Additionally, on August 1, 2022, Louisiana enacted a statewide mandate requiring providers of postnatal care to screen for PPD and related mental health disorders. Using our collaboration with the National Birth Equity Collaborative and combined expertise, we propose to evaluate the effects of the Medicaid postpartum extension (MPE) and PPD screening mandate on screening behaviors, health outcomes, and patient experiences in Louisiana (LA) compared to Mississippi (MS) over three periods (early 2022-2023, middle 2024-2025, and late 2026-2027). We will link electronic health records and Medicaid claims data in Louisiana and Mississippi, allowing us to track screening and follow-up care even after birthing people lose Medicaid coverage. The primary effectiveness measure will be a 3-month composite screening rate for BP, BG, and PPD. Secondary measures include individual screening rates, diagnoses, and management of T2DM, HTN, and PPD. It is also critical to understand contextual factors and health inequities that contribute to disparities in postpartum care and to estimate the cost-effectiveness of these policies. The overall goal is to evaluate effective implementation strategies that aim to improve maternal postpartum health in Medicaid beneficiaries with GDM or PIH. To achieve this goal, the study will have three specific aims. First, we will examine the effectiveness of Louisiana’s MPE and PPD screening mandate on the rates of BG and BP monitoring, PPD screening, rates of T2DM, HTN, and PPD diagnoses, T2DM, HTN and PPD management, health disparities, and health care utilization, as compared to counterparts in Mississippi. The second aim will be to examine the cost-effectiveness and distributional cost- effectiveness of Louisiana’s MPE and PPD screening mandate from the patient, provider, payer, and social perspectives. The third aim will be to examine the complex contextual factors that influence adopting and implementing MPE and PPD screening mandates, and subsequent impacts on healthcare delivery, healthcare utilization, and maternal health equity within and between Louisiana and Mississippi. Findings will inform concurrent and future health policy strategies for informing, engaging, and empowering birthing people to improve maternal health outcomes and eliminate maternal health disparities in the United States.