The Effects of the Medicaid Continuous Coverage Requirement during the Public Health Emergency on Postpartum Coverage and Maternal and Infant Care after Childbirth

项目摘要/摘要 职业目标：我的长期职业目标是成为一名研究健康影响的独立调查员 关于低收入人口获得和使用孕产妇和婴儿保健服务的护理政策。 凭借在索赔数据、主题专业知识和因果推理方法方面的其他技能，我计划构建一个 职业生涯侧重于产生证据以改善孕产妇和儿童健康结果并缩小差距 在美国。职业发展：在被指导期间，我将追求以下培训目标(K99) 奖项阶段：(1)临床母婴健康内容专门知识；(2)声称数据分析技能；(3) 先进的因果方法；(4)专业发展。研究项目：延长产后时间 医疗补助计划有可能解决美国产妇健康状况不佳的问题，并对 1在美国，大约63%的产妇死亡发生在产后，甚至更多 超过一半的人被认为是可以预防的。2然而，尽管产后保健需求很高，但怀孕- 相关医疗补助在产后60天后终止。医疗补助支付了美国近一半的生育费用， 不成比例地涵盖了低收入人口和有色人种的生育。3-5最近 对产后医疗补助的兴趣增加，包括延长美国救援计划(ARP)选项 医疗补助一年后。6在此之前，2020年3月的家庭第一冠状病毒应答法 (FFCRA)阻止了大流行期间医疗补助计划的取消，从而延长了产后医疗补助计划 资格，这可以为目前正在考虑的产后医疗补助政策提供信息。利用罗德岛 所有付款人索赔数据，本提案的具体目标是：K99/1)评估FFCRA对 覆盖范围和产后母婴护理，R00/2)以评估异质性影响 FFCRA关于按种族和族裔划分的结果的报告(R00/3)，以评估新冠肺炎大流行如何影响 延长产后医疗补助资格对护理使用的影响。良师益友：我已经组建了一个高度 布朗大学优秀的专家团队，在我过渡到 研究独立性，由卫生服务、政策和卫生部教授特里维迪博士组成 实践和医学系；Steenland博士，#年人口研究研究助理教授 人口研究和培训中心；Vivier博士，卫生服务、政策和实践教授 儿科学和急诊医学教授；威尔逊博士，教授和卫生部主任 服务、政策和实践，医学教授；流行病学教授、教授萨维茨 妇产科和儿科；Chace-Joukowsky教授兼 妇产科。未来方向：本提案中的培训和研究将为我提供一个 一套独特的专业知识和技能，让我做好准备，实现研究独立并提交R01 使用索赔数据检查产后医疗补助政策中州差异的影响的应用程序。

PROJECT SUMMARY/ABSTRACT Career Goal: My long-time career goal is to become an independent investigator studying the effects of health care policies on access and use of maternal and infant health care services among low-income populations. With additional skills in claims data, subject matter expertise, and causal inference methods, I plan to build a career focused on generating evidence to improve maternal and child health outcomes and reduce disparities in the United States. Career Development: I will pursue the following training aims during the mentored (K99) phase of the award: (1) clinical maternal and infant health content expertise; (2) claims data analysis skills; (3) advanced causal methods, and; (4) professional development. Research Project: Extending postpartum Medicaid has the potential to address poor maternal health in the United States, with additional implications for infant care use and health.1 Approximately 63% of maternal deaths in the U.S. occur postpartum, and more than half are considered to be preventable.2 However, despite high postpartum healthcare needs, pregnancy- related Medicaid ends after 60 days postpartum. Medicaid pays for almost half of all births in the US and disproportionately covers births to the low-income population and people of color.3–5 There has recently been increased interest in postpartum Medicaid, including an American Rescue Plan (ARP) option to extend Medicaid one-year postpartum.6 Prior to this, the March 2020 Families First Coronavirus Response Act (FFCRA) prevented Medicaid disenrollment during the pandemic, thereby extending postpartum Medicaid eligibility, which can inform current postpartum Medicaid policies under consideration. Using the Rhode Island All-Payer claims data, this proposal's Specific Aims are: K99/1) To evaluate the effects of the FFCRA on coverage and maternal and infant care in the postpartum period, R00/2) To evaluate the heterogeneous effects of the FFCRA on outcomes by race and ethnicity, R00/3) To evaluate how the COVID-19 pandemic affected the effects of extended postpartum Medicaid eligibility on care use. Mentorship: I have assembled a highly accomplished team of experts at Brown University to provide mentorship and guidance as I transition to research independence, comprised of Dr. Trivedi, Professor in the Department of Health Services, Policy and Practice and Department of Medicine; Dr. Steenland, Research Assistant Professor of Population Studies in the Population Studies and Training Center; Dr. Vivier, Professor of Health Services, Policy and Practice and Professor of Pediatrics and Emergency Medicine; Dr. Wilson, Professor and Chair of the Department of Health Services, Policy and Practice, and Professor of Medicine; Dr. Savitz, Professor of Epidemiology and Professor of Obstetrics and Gynecology and Pediatrics; and Dr. Tuuli, Chace-Joukowsky Professor and Chair of Obstetrics & Gynecology. Future Directions: The training and research in this proposal will provide me with a unique set of expertise and skills to prepare me to reach research independence and submit an R01 application to examine the effects of state variation in postpartum Medicaid policies using claims data.