Policy effects on gender minority health and evidence from the implementation of gender affirming coverage in Medicaid

项目总结/摘要 这个AHRQ指导研究科学家职业发展奖（K 01）将建立博士亚历克斯麦克道尔 作为性和性别少数（SGM）健康政策的国家专家，领导卫生服务研究， 确定解决SGM健康不公平问题的政策方法。 在本K 01的支持下，McDowell博士将使用Medicaid索赔和遭遇数据来评估影响 以及在医疗补助中实施性别平等覆盖政策，产生新的和及时的证据 利益相关者可以用来告知联邦和州的政策。采用交错引入性别 为了确认2016-2022年各州的覆盖政策，本研究将采用差异中的差异方法 估计这些政策对使用性别平等保健服务的影响（例如，激素和 外科手术）在性别少数群体中（即，跨性别和性别多样性（GM）个体。鉴于显著的心理 美国转基因人群中的健康不平等以及使用性别 肯定转基因个体的服务和改善的心理健康结果，麦克道尔博士还将研究 在医疗补助中采用性别肯定覆盖政策对不良心理健康结果的影响， 包括精神病住院和自杀。最后，麦克道尔博士将使用 实施研究综合框架（CFIR）和与Medicaid的半结构化访谈 利益攸关方确定在以下领域执行性别平等覆盖政策的障碍和促进因素： 医疗补助，包括医疗补助融资模式之间的差异（例如，收费服务vs.管理式护理）。 该项目将把联合收割机严格的准实验性政策评估与有关障碍的背景数据结合起来， 实施的促进者，以全面了解医疗补助性别的影响 确认关于转基因健康和保健的覆盖政策。 拟议的研究建立在麦克道尔博士在卫生服务研究方法的培训基础上， 以及之前在商业保险个人中对转基因健康政策的研究。她的训练计划将支持 她的目标是发展医疗补助融资和管理式护理方面的专业知识， 性别肯定护理，并获得执行科学研究的熟练程度。通过研究 和培训，麦克道尔博士将准备领导研究，系统地评估影响， 以及在州和联邦两级实施影响转基因个体的现行政策变化， 成为性和性别少数群体健康政策的主要专家。

PROJECT SUMMARY/ABSTRACT This AHRQ Mentored Research Scientist Career Development Award (K01) will establish Dr. Alex McDowell as a national expert in sexual and gender minority (SGM) health policy, leading health services research that identifies policy approaches to address SGM health inequities. With the support of this K01, Dr. McDowell will use Medicaid claims and encounter data to evaluate the impact and implementation of gender affirming coverage policies in Medicaid, generating novel and timely evidence that stakeholders can use to inform federal and state policies. Using the staggered introduction of gender affirming coverage policies across states, 2016-2022, this study will employ difference-in-differences methods to estimate the effect of these policies on use of gender affirming health care services (e.g., hormones and surgery) among gender minority (i.e., transgender and gender diverse, GM) individuals. Given notable mental health inequities among the GM population in the U.S. and the demonstrated link between use of gender affirming services and improved mental health outcomes for GM individuals, Dr. McDowell will also study the effects of adoption of gender affirming coverage policies in Medicaid on adverse mental health outcomes, including psychiatric hospitalizations and suicidality, among GM enrollees. Lastly, Dr. McDowell will use the Consolidated Framework for Implementation Research (CFIR) and semi-structured interviews with Medicaid stakeholders to identify barriers and facilitators to implementation of gender affirming coverage policies in Medicaid, including differences across Medicaid financing models (e.g., fee-for-service vs. managed care). This project will combine rigorous quasi-experimental policy evaluation with contextual data on the barriers and facilitators to implementation to provide a comprehensive understanding of the impact of Medicaid gender affirming coverage policies on GM health and health care. The proposed research builds upon and extends Dr. McDowell’s training in health services research methods and prior research in GM health policy among commercially insured individuals. Her training plan will support her goals of developing expertise in Medicaid financing and managed care, acquiring skills in the measurement of gender affirming care, and gaining proficiency in implementation science research. Through the research and training in this K01, Dr. McDowell will be prepared to lead studies that systematically evaluate the effects and implementation of ongoing policy changes affecting GM individuals at the state and federal levels and to be a leading expert in sexual and gender minority health policy.