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

突发公共卫生事件期间医疗补助持续覆盖要求对产后覆盖和产后母婴护理的影响

• 批准号: 10643130
• 负责人: Erica L Eliason
• 金额: $ 12.05万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643130
• 关键词: Address; Affect; American; Award; Birth; Black Populations; COVID-19; COVID-19 mortality; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Childbirth; Clinical; Contraceptive methods; Coronavirus; Data; Data Analyses; Databases; Department chair; Developed Countries; Development; Discipline of obstetrics; Disparity; Eligibility Determination; Emergency Medicine; Epidemiology; Ethnic Origin; Family; Freezing; Future; Goals; Gynecology; Health; Health Insurance; Health Policy; Health Services; Health Services Accessibility; Healthcare; Healthcare promotion; Hispanic Populations; Income; Individual; Infant; Infant Care; Infant Health; Insurance; Link; Low Income Population; Low income; Maternal Health; Maternal Health Services; Maternal Mortality; Maternal and Child Health; Measures; Medicaid; Medicaid eligibility; Medicine; Mentors; Mentorship; Methods; National Institute of Child Health and Human Development; Outcome; Pediatrics; Persons; Phase; Policies; Population Study; Postpartum Depression; Postpartum Period; Pregnancy; Pregnancy loss; Qualifying; Race; Research; Research Assistant; Research Personnel; Research Priority; Research Project Grants; Rhode Island; Risk; Severities; Techniques; Testing; Time; Training; United States; Universities; Variant; career; career development; demographics; disparity reduction; ethnic disparity; experience; federal poverty level; health care availability; health care disparity; health care service; health disparity; health outcome disparity; improved; infant outcome; interest; maternal morbidity; pandemic disease; people of color; poor health outcome; postpartum care; postpartum health; prevent; professor; public health emergency; racial disparity; response; skills; treatment effect

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.

项目概要/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研究者 关于低收入人群获得和使用母婴保健服务的护理政策。 凭借索赔数据、主题专业知识和因果推理方法方面的额外技能，我计划建立一个 职业重点是提供证据以改善孕产妇和儿童健康结果并减少差距 在美国的职业发展：我将在指导期间追求以下培训目标（K99） 奖励阶段：（1）临床母婴健康内容专业知识；（3）理赔数据分析技能； (4) 专业发展研究项目：延伸产后。 医疗补助有可能解决美国孕产妇健康状况不佳的问题，并对以下方面产生额外影响： 婴儿护理的使用和健康。1 在美国，大约 63% 的孕产妇死亡发生在产后，而且更多 超过一半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，为美国近一半的分娩提供医疗补助。 不成比例地涵盖低收入人口和有色人种的出生。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 产后一年的医疗补助。6 在此之前，2020 年 3 月《家庭首次冠状病毒应对法案》 (FFCRA) 在大流行期间阻止了医疗补助的退出，从而延长了产后医疗补助 资格，这可以为正在考虑的当前产后医疗补助政策提供信息。 所有付款人索赔数据，该提案的具体目标是： K99/1) 评估 FFCRA 对 覆盖率以及产后母婴护理，R00/2) 评估异质性效应 FFCRA 按种族和民族划分的结果，R00/3）评估 COVID-19 大流行的影响 延长产后医疗补助资格对护理使用的影响：我收集了一份高度评价的报告。 布朗大学的专家团队在我过渡到 研究，独立性，由卫生服务、政策和部门教授 Trivedi 博士组成 Steenland 博士，人口研究助理教授 人口研究和培训中心；Vivier 博士，卫生服务、政策和实践教授 儿科和急诊医学教授；威尔逊博士，卫生系教授兼系主任 服务、政策和实践以及医学教授萨维茨博士，流行病学教授兼教授 妇产科和儿科系；以及 Chace-Joukowsky 教授兼主席 Tuuli 博士 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，帮助我做好研究独立性并提交 R01 的准备 申请使用索赔数据检查州变化对产后医疗补助政策的影响。