The Role of Expanded Medicaid in Maternal Health in the Late Postpartum Period - Modified PROJECT SUMMARY/ABSTRACT: Maternal morbidity and mortality in the United States have risen 75% this century, with alarming racial disparities. Over half of maternal deaths occur in the postpartum period, and 23% of these occur past 6 weeks after delivery. Most postpartum deaths and many morbidity outcomes could be prevented by addressing underlying causes. States are required to provide Medicaid coverage to pregnant women in households below 138% of the Federal poverty level through postpartum day 60. After that, Medicaid eligibility reverts to the income limits for parents, which are typically much lower. This can leave many postpartum people vulnerable to disruptions in care just as cardiovascular, endocrine, behavioral health, and family planning services are often needed. Prior research showed that Medicaid expansion is associated with decreased maternal mortality and reduced Black-White disparities in maternal death. However, it is not known whether expanding Medicaid coverage is effective at promoting timely healthcare use and better health outcomes through the full postpartum year across racial and ethnic groups, and what role patient experiences of healthcare access and quality play in these effects. The purpose of this study is to identify changes in maternal healthcare use and health outcomes 60 days to 1 year after delivery that are associated with state Medicaid expansions, whether the effects of expansion vary by maternal race or ethnicity, and whether patient-reported access and quality mediate any relationships between expansion and outcomes. This study will be a secondary analysis of data from the Medical Expenditure Panel Survey (MEPS), a national household survey of health and healthcare use that can produce representative statistics across racial and ethnic groups. All women with a live birth in MEPS observation periods spanning 2007-2019 will be included in the study sample. Primary outcomes include maternal morbidity conditions; self-rated physical and mental health; occurrence and frequency of medical provider office visits, emergency department visits, and hospitalization; and prescription contraceptive and antidepressant treatment persistence. We will employ a quasi-experimental difference-indifferences design, with differences coming from time (before vs. after Medicaid expansion) and “treatment” (expansion vs. non-expansion states). We will identify differential effects of expansion by maternal race and ethnicity, and we will test for mediation effects when both expansion and self-reported access or quality are associated with primary outcomes. Data analysis and results interpretation will be guided by a robust community advisory board consisting of people with lived experience and expertise in maternal health and racial disparities. The MEPS probability sample design enables extrapolation of findings to the national population over a 13-year period. Therefore, study findings will reliably inform optimal policy for postpartum coverage duration, especially in Medicaid programs. This study will also provide preliminary data for a future R01-funded project that directly examines the impact of extending postpartum Medicaid under the American Rescue Plan.
