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

项目摘要 在美国，州医疗补助计划支付了近一半的出生费用，融资160多万 2019年出生。联邦法律要求各州向低收入家庭提供与怀孕有关的医疗补助。 怀孕的人到产后60天，此后四分之一的人没有保险。实质性和 与怀孕有关的不良后果，包括产妇发病率和死亡率， 发生在医疗补助支付生育的个人中，以及与妊娠相关的医疗补助覆盖范围结束后。 产后医疗补助资格延长（PME）至产后一年是一种新兴的策略， 改善低收入母亲和儿童的保险登记、医疗保健和健康状况。年通过 为应对COVID-19突发公共卫生事件，两项联邦法律加快了 PMEs。首先，2020年3月的《家庭第一冠状病毒应对法案》（FFCRA）阻止各州 在公共卫生紧急情况下取消医疗补助受益人。于是，吴建民创造了一个 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将于2022年4月开始，由联邦提供配套资金。对这些政策的严格评估是迫切需要的。 需要告知国家决定采用PME，并确定这些政策是否具有预期的效果。 在产后一年内改善孕产妇、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，准实验性的评估， 政策采用的变化，以提供有关FFCRA和ARPA的及时数据，以及1） 产妇保险登记、医疗保健使用和健康; 2）儿童保险登记、医疗保健使用， 和健康;和3）随后怀孕的结果，包括短解释间隔的比率 和早产（NOT-HS-14-004）。考虑到那些靠医疗补助金生育的人中 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对种族健康公平性的影响 （NOT-HS-21-014）。 拟议的一系列评价将产生数据，直接说明这些前所未有的大规模 政策干预与改善孕产妇和儿童健康或种族和族裔 出生后一年的差距。我们将及时得出调查结果， 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， 低收入母亲和儿童在出生后一年的人口差异。

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.