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

项目总结 州医疗补助计划支付了美国近一半的生育费用，资助了160多万人 2019年出生人数。联邦法律要求各州为低收入者提供与怀孕相关的医疗补助 怀孕的人在产后60天后，每4人中就有1人没有保险。实实在在的 与妊娠有关的不良后果，包括产妇发病率和死亡率，所占比例越来越高 发生在有医疗补助付费分娩的个人中，并且在与怀孕相关的医疗补助覆盖范围结束后发生。 产后医疗补助资格延长(PME)至产后一年是一项新兴的战略 改善低收入母亲和儿童的保险参保、医疗保健和健康状况。传入 应对新冠肺炎突发公共卫生事件，两项联邦法律加快实施 太平洋海洋生态系统。首先，2020年3月的家庭第一冠状病毒反应法(FFCRA)阻止各州 在公共卫生紧急情况下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)允许各州通过 太平洋海洋生态系统将于2022年4月在联邦配套基金的支持下启动。迫切需要对这些政策进行严格的评估 需要告知国家采用PME的决定，并确定这些政策是否具有预期的 在出生后第二年改善母婴和妊娠相关健康的效果。 为正在进行的循证决策提供信息，填补妇幼保健方面的这一重大空白 研究，我们的多学科团队将进行严格的准实验评估，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) 孕妇保险投保、医疗保健使用和健康；2)儿童保险投保、医疗保健使用、 和健康；以及3)后续妊娠的结果，包括口译间隔期短的比率 早产(非HS-14-004)。考虑到有不成比例的医疗补助出生的人 在产后一年经历不良健康事件的是低收入和黑人、土著或 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 (非HS-21-014)。 拟议的一套评估将产生数据，直接告知这些史无前例的、大规模的 政策干预与改善孕产妇和儿童健康或种族和族裔有关 出生后一年的差异。我们将及时生成调查结果，为持续的、以证据为基础的 制定政策以解决美国的孕产妇健康危机。最终，我们的目标是改善健康和减少 在人口层面上，低收入母亲和儿童在出生后一年的差距。

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.