Medicaid Policy Levers in Maternal and Child Health: Enrollment, Services, and Access

Session Submission Type: Panel

Abstract

Medicaid is an important health insurance mechanism for insuring the maternal and child health population, covering over 40% of births and 49% of children in the US. As a result, policies that dictate Medicaid coverage and services available to Medicaid enrollees have far-reaching implications for promoting maternal and child health outcomes. This panel includes mixed-methods examination of policies implemented from 2020 to the present—some likely to increase enrollment and others to decrease it—focusing on both their implementation and their impact on enrollment and outcomes.

The first paper uses a national survey dataset and a difference-in-difference approach to identify the effects of implementing continuous eligibility under the March 2020 Families First Coronavirus Response Act (FFCRA) on children’s health, development, and educational outcomes overall and by race-ethnicity. This study found that continuous Medicaid was associated with increases in insurance that allowed children to access providers and additional improvements in health and care access for Hispanic children. This study has implications for health care access and racial-ethnic health disparities resulting from the `unwinding’ of the FFCRA and continuous eligibility under the Consolidated Appropriations Act of 2023.

The second paper uses state Medicaid data for New York and Texas and a quasi-experimental interrupted time series analysis design to test whether continuous postpartum Medicaid coverage increased postpartum screenings and outpatient utilization among women with hypertensive disorders in pregnancy (HDP) and diabetes in pregnancy (DIP). This research found that extended Medicaid coverage increased 12-month screening and outpatient utilization among women with pregnancy complications. These findings suggest that 12-month postpartum Medicaid extensions may help to increase access to healthcare and improve maternal health.

The third paper uses primary qualitative data to examine how health and social care stakeholders experience implementation of the New York Medicaid 1115 Waiver (starting January 2025) that expands enhanced social services to address food, housing, and transportation needs during pregnancy and the first year after birth. This study will examine themes around challenges in health and social care system integration, and reflections around access challenges, such as language barriers, complex eligibility criteria, and fragmented referral pathways. This research seeks to highlight modifiable levers and concrete friction points to provide policymakers with actionable insights and strengthen future social needs-related waivers.

Finally, the fourth paper uses national Medicaid data and key informant interviews to assess pregnant and postpartum women who may be at risk of coverage losses under the One Big Beautiful Bill Act (OBBBA), explore challenges states may face in ensuring coverage continuity, and identify actions that state, federal, and other stakeholders can take to protect coverage. This research found that over 100,000 pregnant and postpartum women could be at risk of disenrollment under OBBBA. These findings highlight the importance of ensuring timely identification of pregnancy to provide exemptions from new requirements while managing privacy and legal concerns.

Policy Area

• Health Policy

Chair

• Jennifer Boutin Mane, New York State Department of Health

Discussants

• Sarah Gordon, Boston University

• Laura Dague, Texas A&M University

Organizer

• Renata Howland, New York University

Individual Presentations

• Continuous Medicaid Eligibility During COVID-19 and Children’s Health, Access to Care, Development, and Academic Outcomes - Presenting Author: Erica Eliason, Rutgers University

• Medicaid extensions and postpartum follow-up after pregnancy complications: an interrupted time series analysis - Presenting Author: Renata Howland, New York University

• Facilitators and Barriers to Addressing Health-Related Social Needs: A Qualitative Study of Medicaid Waiver Implementation - Presenting Author: Carol Duh-Leong, New York University

• Ensuring Continuous Coverage for Pregnant and Postpartum Medicaid Enrollees under OBBBA - Presenting Author: Jennifer Haley, Urban Institute