Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Medicaid,

Intervention Description: This study measures effects on the receipt of preventive care among children enrolled in Georgia's Medicaid or Children's Health Insurance Program associated with the implementation of new elementary school-based health centers. The study sites differed by geographic environment and predominant race/ethnicity (rural white, non-Hispanic; black, small city; and suburban Hispanic). A quasi-experimental treatment/control cohort study used Medicaid/Children's Health Insurance Program claims/enrollment data for children in school years before implementation (2011-2012 and 2012-2013) versus after implementation (2013-2014 to 2016-2017) of school-based health centers to estimate effects on preventive care among children with (treatment) and without (control) access to a school-based health center. Data analysis was performed in 2017-2019. There were 1,531 unique children in the treatment group with an average of 4.18 school years observed and 1,737 in the control group with 4.32 school years observed. A total of 1,243 Medicaid/Children's Health Insurance Program-insured children in the treatment group used their school-based health centers.

Intervention Results: Significant increases in well-child visits (5.9 percentage points, p<0.01) and influenza vaccination (6.9 percentage points, p<0.01) were found for children with versus without a new school-based health center. This represents a 15% increase from the pre-implementation percentage (38.8%) with a well-child visit and a 25% increase in influenza vaccinations. Increases were found only in the 2 school-based health centers with predominantly minority students. The 18.7 percentage point (p<0.01) increase in diet/counseling among obese/overweight Hispanic children represented a doubling from a 15.3% baseline.

Conclusion: Implementation of elementary school-based health centers increased the receipt of key preventive care among young, publicly insured children in urban areas of Georgia, with potential reductions in racial and ethnic disparities.

Study Design: Quasi-experimental treatment/control cohort study

Setting: Elementary schools with school-based health centers in urban areas in Georgia

Population of Focus: Children with (treatment) and without (control) access to a school-based health center

Sample Size: Total of 1,531 unique children in the treatment group (those with access to school-based health centers) and 1,737 unique children in the control group (those without access to school-based health centers)

Age Range: Children aged 7 to 9 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Expanded Insurance Coverage, Medicaid, PAYER

Intervention Description: This observational, cohort study assessed the rate of insured visits for children pre- to post-ACA across four parental insurance groups (always insured, gained Medicaid, discontinuously insured, never insured) using Poisson mixed effects models.

Intervention Results: Insurance rates were highest (~95 insured visits/100 visits) for children of parents who were always insured; rates were lowest for children of parents who were never insured (~83 insured visits/100 visits). Children with a parent who gained Medicaid had 4.4% more insured visits post- compared to pre-ACA (adjusted relative rates = 1.044, 95% confidence interval: 1.014, 1.074). When comparing changes from pre- to post-ACA between parent insurance groups, children's insured visit rates were significantly higher for children of parents who gained Medicaid (reference) compared to children of parents who were always insured (adjusted ratio of rate ratio: 0.963, confidence interval: 0.935-0.992). Despite differences in Medicaid eligibility for children and adults, health insurance patterns were similar for linked families seen in CHCs.

Conclusion: Findings suggest consideration should be paid to parent health insurance options when trying to increase children's coverage.

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Care Coordination, Medicaid,

Intervention Description: N/A

Intervention Results: Children who were not white, living in non-English households, with less family income or education, or who were uninsured had lower rates of access to a medical home and its components. A medical home was associated with beneficial child outcomes for all six of the outcomes and the family-centered care component was associated with better results in five outcomes. ED visits were less likely for children who received care coordination (aOR 0.81, CI 0.70-0.94).

Conclusion: Our study highlights the role of key components of the medical home and the importance of access to family-centered health care that provides needed coordination for children. Health care reforms should consider disparities in access to a medical home and specific components and the contributions of each component to provide quality primary care for all children.

Study Design: We analyzed data from the 2016-2017 National Survey of Children's Health (NSCH) to assess five key medical home components - usual source of care, personal doctor/nurse, family-centered care, referral access, and coordinated care - and their associations with child outcomes. Health outcomes included emergency department (ED) visits, unmet health care needs, preventive medical visits, preventive dental visits, health status, and oral health status. We used multivariate regression controlling for child characteristics including age, sex, primary household language, race/ethnicity, income, parental education, health insurance coverage, and special healthcare needs.

Setting: NSCH survey; United States

Population of Focus: Practitioners in children's health

Sample Size: 61572

Age Range: 0-17

Intervention Components (click on component to see a list of all articles that use that intervention): Prenatal Care Access, Medicaid,

Intervention Description: The study proposed several intervention features based on participant ideas for change. These intervention features were intended to address the unique unmet needs and preferences of pregnant women with varying degrees of unscheduled care utilization. The proposed intervention features included: 1. Social Support: - Integration of community health workers (CHWs) into care teams and existing childbirth education. - Connecting pregnant individuals with social services resources. - Group prenatal care support. 2. Care Delivery: - Health information exchange. - Prenatal passport cards or applications. - Visit checklists. - Integration of technology already in use. 3. Access: - Advanced access scheduling. - Enhanced care team visibility. - Drop-in pregnancy support center. - Insurance screening and enrollment. - Integration of CHW support for navigation and continuity. These intervention features were intended to address the participants' expressed needs for social support, improved care delivery, and enhanced access to outpatient prenatal care. The study aimed to leverage these person-centered intervention elements to improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes

Intervention Results: he study identified three overarching thematic domains from participant ideas for improving prenatal care: social support, improved care delivery, and improved access to outpatient prenatal care. The study found that pregnant women with frequent unscheduled care utilization had unique unmet needs compared to those with no prior unscheduled visits. Participants in Group 1 overwhelmingly wanted to feel heard and centered by providers, while those in Group 2 expressed ambivalence about increased social support. The study proposed several intervention features based on participant ideas for change, including integration of CHWs into care teams, group prenatal care support, and advanced access scheduling. The study concluded that these person-centered intervention elements could improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes

Conclusion: The study concluded that low-income, Medicaid-insured, predominantly Black pregnant women face unique unmet needs in prenatal care delivery, which can be addressed through person-centered intervention elements. The study proposed several intervention features based on participant ideas for change, including integration of CHWs into care teams, group prenatal care support, and advanced access scheduling. These intervention features were intended to address the participants' expressed needs for social support, improved care delivery, and enhanced access to outpatient prenatal care. The study aimed to leverage these person-centered intervention elements to improve trust and impact of prenatal care, with the potential to advance equitably improved outcomes. The study highlights the importance of engaging pregnant women in the design of interventions to improve prenatal care delivery and reduce disparities in maternal and infant health outcomes

Study Design: The study design was a qualitative, participatory action research approach. The researchers conducted in-depth, semi-structured interviews with pregnant women at the point of unscheduled hospital-based obstetric care in a triage unit. The interviews were designed to explore the participants' perspectives on group prenatal care, community health worker (CHW) interventions, and ideas for improving care. The study team then used grounded theory to develop a coding structure and identify major themes that emerged from the data, relating to participant ideas for improving care. The resulting intervention framework was presented to all study team members for validation, adjustment, and finalization.

Setting: The setting for this study was focused on low-SES, Medicaid-insured, predominantly Black pregnant women. The study aimed to understand the experiences and perspectives of pregnant individuals who are frequent and infrequent users of unscheduled care in the emergency room and obstetric triage. The insights and recommendations provided in the study are based on the narratives and experiences of these specific groups of pregnant individuals, highlighting the importance of tailoring prenatal care delivery to meet the unique needs of this population.

Population of Focus: The target audience for this study was low-income, Medicaid-insured, predominantly Black pregnant women with varying degrees of unscheduled care utilization. The study aimed to understand the perspectives and experiences of this specific demographic group in order to identify unmet needs and propose interventions to improve prenatal care delivery tailored to their unique requirements. The findings and recommendations presented in the study are intended to inform healthcare providers, policymakers, and organizations involved in prenatal care for this target audience, with the goal of enhancing access to early prenatal care and improving perinatal outcomes.

Sample Size: he sample size for this study was 40 participants, who were enrolled and categorized as either Group 1 (n = 20) or Group 2 (n = 20). The participants were low-income, Medicaid-insured, predominantly Black pregnant women with varying degrees of unscheduled care utilization. The study team conducted in-depth, semi-structured interviews with these participants to explore their perspectives on barriers and facilitators of health and ideas for improvement in care delivery, with a focus on the potential role of community health workers and social support. The study team then used modified grounded theory to develop general and subset themes by study group and mapped these themes to potential intervention features.

Age Range: The study did not provide a specific age range for the participants. However, it did report that the mean age for Group 1 was 25.5 years and for Group 2 was 25.0 years. The study also reported that all enrolled participants self-identified as cis-gender women and were predominantly Black (95%).

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), PROVIDER/PRACTICE, Outreach (Provider), POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: The authors obtained Medicaid eligibility, claims, and provider data before and after the fee increase, in 2006 and 2009 through 2012, respectively. Their analysis examined changes in utilization rates, service mix, expenditures, and dentists' participation. The authors qualitatively assessed the general impact of the recession on utilization rate changes.

Intervention Results: The percentage of preventive dental services among continuously enrolled children stayed relatively constant from pretest to posttest (24.1% in 2006 at pretest and 22.7%, 23.1%, 23.3%, and 24.4% in 2009, 2010, 2011, and 2012 respectively).

Conclusion: The Medicaid fee increase, program improvements, and the recession had a dramatic impact on reducing disparities in children's access to dental care in Connecticut.

Study Design: QE: pretest-posttest

Setting: Connecticut

Population of Focus: Children continuously enrolled in Medicaid (Healthcare for UninSured Kids and Youth A program) for at least 11 months and 1 day within a calendar year

Data Source: Medicaid enrollment and encounter data

Sample Size: 2006 (n=161,130) 2009 (n=166,787) 2010 (n=204,550) 2011 (n=215,377) 2012 (n=214,680)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: The intervention in this study was the implementation of a state policy mandating inpatient access to immediate postpartum LARC.

Intervention Results: We identified 17,848 deliveries prepolicy and 18,555 deliveries postpolicy. Immediate postpartum LARC was used by 0.5% (monthly range 0–2.1%) of patients prepolicy and 11.6% (monthly range 8.3–15.4%) of patients postpolicy. Levonorgestrel intrauterine devices (IUDs) were used by 56.5%, implants by 29.1%, and copper IUDs by 14.5% of LARC users. Characteristics associated with LARC use included younger age, public insurance, non-White race, Hispanic or Latina ethnicity, higher body mass index, sexually transmitted infection in pregnancy, and tobacco use. Long-acting reversible contraceptive users had a lower rate of repeat pregnancy at 12 months postpartum compared with the non-LARC group (1.9% vs 3.6%, P<.001).

Conclusion: Immediate postpartum LARC use increased after a state policy change mandated universal access and was associated with decreased pregnancy rates in the first year postdelivery.

Study Design: Retrospective cohort

Setting: 3 hospitals within the Cleveland Clinic health system in Ohio

Sample Size: 36403 deliveries

Age Range: No age range given,

Intervention Components (click on component to see a list of all articles that use that intervention): Expanded Insurance Coverage, Medicaid, PAYER

Intervention Description: We assessed whether state policies that allow children to remain covered in Medicaid for a 12-month period, regardless of fluctuations in income, are associated with health and health care outcomes, after controlling for individual factors and other Medicaid policies.

Intervention Results: Continuous eligibility was associated with improved rates of insurance, reductions in gaps in insurance and gaps due to application problems, and lower probability of being in fair or poor health. For children with special health care needs, it was associated with increases in use of medical care and preventive and specialty care access. However, continuous eligibility was not associated with health care utilization outcomes for the full sample.

Conclusion: Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Health Insurance Coverage, Public Insurance (State),

Intervention Description: Fluctuating insurance coverage, or churning, is a recognized barrier to health care access. We assessed whether state policies that allow children to remain covered in Medicaid for a 12-month period, regardless of fluctuations in income, are associated with health and health care outcomes, after controlling for individual factors and other Medicaid policies. This cross-sectional study uses a large, nationally representative database of children ages 0 to 17.

Intervention Results: Continuous eligibility was associated with improved rates of insurance, reductions in gaps in insurance and gaps due to application problems, and lower probability of being in fair or poor health. For children with special health care needs, it was associated with increases in use of medical care and preventive and specialty care access. However, continuous eligibility was not associated with health care utilization outcomes for the full sample.

Conclusion: Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

Study Design: Cross-sectional study

Setting: State Medicaid policies

Population of Focus: Children aged 0 to 17 years old with annual family incomes at or below 138% of the federal poverty line (FPL) and a subpopulation of children in low-income families with special health care needs, based on specific criteria related to health problems that require special assistance or limit the child's abilities

Sample Size: 22,622 respondents aged 0 to 17 years old with annual family incomes at or below 138% of the federal poverty line (FPL); subpopulation of 6,081 children with special health care needs in low-income families

Age Range: Children and adolescents 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Medicaid Reform, STATE

Intervention Description: The goal of this study was to use claims data linked with community-level measures to evaluate the impact of preventive services on the time to subsequent restorative, advanced restorative, and complex dental treatment among children enrolled in the Virginia Medicaid program.

Intervention Results: The analysis included 430,594 children (10,204,182 claims). A log-rank test showed significant differences (P < 0.001) between the times to treatment of those who had a preventive service and those who did not have a preventive service prior to a treatment service. Both Kaplan-Meier curves and the adjusted HR (1.88; 95% confidence interval [CI], 1.46-2.15) indicated that children without preventive services were more likely to have basic restorative treatment at an earlier age along with advanced restorative treatment (HR, 1.52; 95% CI, 1.28-1.80) and complex treatment (HR, 2.13; 95% CI, 1.68-2.61).

Conclusion: In a population of Medicaid-enrolled children, children who did not receive preventive services were significantly more likely to have treatment at an earlier age than those who did receive preventive services.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid,

Intervention Description: To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access. Secondary administrative data were obtained from Medicaid programs in one state that transitioned foster youth from an FFS to an MC (Texas) and another state, comparable in population size and racial/ethnic diversity, which continuously enrolled foster youth in an FFS system (Florida). Eligible participants were foster youth (aged 0-18 years) enrolled in these states between 2006 and 2010 (n = 126,714). A Puhani approach to difference-in-difference was used to identify the effect of transition after adjusting for race/ethnicity, gender, and health status. Data were used to calculate access to primary and preventive care as well as ED reliance. ED reliance was operationalized as the number of ED visits relative to the number of total ambulatory visits; high ED reliance was defined as ≥33%.

Intervention Results: The transition to MC was associated with a 6% to 13% increase in access to primary care. Preventive care visits were 10% to 13% higher among foster youth in MC compared to those in FFS. ED reliance declined for the intervention group but to a lesser extent than did the control group, yielding a positive mean percentage change.

Conclusion: Foster youth access to care may benefit from a Medicaid MC delivery system, particularly as the plans used are designed with the unique needs of this vulnerable population.

Study Design: Quasi-experimental study

Setting: Medicaid programs in two states: Texas and Florida

Population of Focus: Foster youth aged 0-18 years enrolled in the Medicaid programs of Texas and Florida

Sample Size: In Texas, the mean number of enrollees was 38,569; In Florida, the mean number of enrollees was 24,611

Age Range: Foster youth aged 0 to 18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-forservice (FFS) Medicaid to managed care (MC) on this access. Secondary administrative data were obtained from Medicaid programs in one state that transitioned foster youth from an FFS to an MC (Texas) and another state, comparable in population size and racial/ethnic diversity, which continuously enrolled foster youth in an FFS system (Florida).

Intervention Results: The transition to MC was associated with a 6% to 13% increase in access to primary care. Preventive care visits were 10% to 13% higher among foster youth in MC compared to those in FFS. ED reliance declined for the intervention group but to a lesser extent than did the control group, yielding a positive mean percentage change.

Conclusion: Foster youth access to care may benefit from a Medicaid MC delivery system, particularly as the plans used are designed with the unique needs of this vulnerable population

Study Design: The quasi-experimental design of this study capitalizes on a natural experiment in which one state transitioned foster youth from an FFS to an MC delivery system exclusive to foster youth while another state, comparable in population size and racial/ethnic diversity, continuously enrolled foster youth in an FFS system.

Setting: Two states with a Medicaid Managed Care or Fee for Service system

Population of Focus: Eligible participants were foster youth (aged 0–18 years) enrolled in two states between 2006 and 2010.

Sample Size: 126,714 children and youth

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Expanded Insurance Coverage, PAYER

Intervention Description: The Affordable Care Act (ACA) has the potential to address some of the health care needs of former foster youth through the Medicaid eligibility expansion to low-income adults and by extending Medicaid eligibility up to age twenty-six for former foster youth.

Intervention Results: Using the 2011-18 National Youth in Transition Database, we found that Medicaid expansion increased Medicaid coverage among former foster youth by 10.1 percentage points, and the age extension increased coverage by 3.4 percentage points. There is suggestive evidence of positive spillovers for both policies. Our findings imply that the ACA improved Medicaid coverage among former foster youth, with the largest effects from Medicaid expansion.

Conclusion: The modest effects of the Medicaid age extension may imply a need to revise enrollment, recertification, outreach, and eligibility determination processes to further increase Medicaid coverage among former foster youth.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, Medicaid

Intervention Description: Research has shown that the ACA's Medicaid expansions have reduced uninsurance among women of reproductive age, but there may be variation in coverage effects even within this population. Using data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women without children, postpartum mothers, and mothers of children older than one year in expansion states to non-expansion states, before and after the expansions. This nationally representative data is used to estimate the effect of ACA's Medicaid expansions on Medicaid coverage of low-income reproductive-aged women, and whether there are different relative effects for women without children, women who have given birth in the past year, and women who have a child older than one year.

Intervention Results: We fine variation in impacts within the population of reproductive-aged women. Childless women experience the largest gains in Medicaid coverage while postpartum mothers experience the smallest gains; mothers of children greater than one year old are in the middile. More specifically, the ACA’s Medicaid expansion increased Medicaid coverage among adult women with incomes between 101 and 200% of the federal poverty line (FPL) without children by 10.7 percentage points (54%, p < 0.01). Coverage of mothers with children older than one year increased by 9.5 percentage points (34%, p < 0.01). Coverage of mothers with infants rose by 7.9 percentage points (21%, p < 0.01). Within the population of adult reproductive-aged women, we find a "fanning out" of effects from the expansions. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.

Conclusion: Within the population of adult reproductive-aged women, we find a “fanning out” of effects from the ACA’s Medicaid expansions. Childless women experience the largest gains in coverage while mothers of infants experience the smallest gains; mothers of children greater than one year old fall in the middle. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (Medicaid expansion and non-expansion states)

Population of Focus: Reproductive aged low-income women at varying childbearing stages before and after the expansions

Sample Size: 1,977,098 low-income adult women

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Provider Training/Education, Media Campaign (Print Materials, Public Address System, Social Media),

Intervention Description: We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign.

Intervention Results: Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90-7.61, P < 0.001) during the 2015-2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12-14.37, P = 0.046).

Conclusion: The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Study Design: Difference in differences design

Setting: Delaware (statewide compared to 15 other states)

Sample Size: 4815 women in Delaware; 88470 women in 15 comparison states

Age Range: 15-50

Intervention Components (click on component to see a list of all articles that use that intervention): , Referrals, Expanded Insurance Coverage; Medicaid, Enrollment Assistance, PATIENT_CONSUMER, STATE, PAYER, Expanded Insurance Coverage, Medicaid

Intervention Description: The ACA Medicaid expansion is one of the most significant recent public investments in health insurance. The ACA was designed as a comprehensive reform of health care in the U.S., and one of its priorities was to reduce uninsurance. An important question in an evaluation of the Medicaid expansion is whether it had effects on health or well-being through enrollment in other social safety net prorams. This study investigates Medicaid expansion’s potential spillover participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program). In addition to providing public insurance, the policy connects individuals to SNAP, affecting social determinants of health such as hunger. We use difference-in-differences regression to estimate the effect of the Medicaid expansion on SNAP participation among approximately 414,000 individuals from across the U.S. Not all states participated in the ACA Medicaid expansion, and there was inconsistent timing among those who did. This state-time variation in implementation provides a natural experiment for investigating the relationship between the two programs. Our study contributes new evidence on an important policy topic.

Intervention Results: SNAP, by addressing nutritional needs, can improve social determinants of health. We find support for our first hypothesis that Medicaid expansion leads to greater SNAP participation. We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. The increase is likely a combination of new enrollments and continued participation among individuals who otherwise would have been disenrolled. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. More specifically, there is a 2.4 percentage point increase in the average rates of participation in Medicaid and SNAP for households with children implying that some low-income children benefit indirectly through more access to SNAP. Furthermore, the increase in SNAP in very low-income households is likely to provide substantial improvements in access to food. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs.

Conclusion: We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. This main finding is consistent with the Oregon Health Insurance Experiment, as well as the handful of ACA Medicaid expansion studies in this area of research. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs. Although SNAP is a federal program and Medicaid is a state-federal program, states can streamline applications, recertifications, and other hurdles to accessing and staying enrolled in these programs. We find no spillover effect for ABAWDs, however, who are a vulnerable group of adults that need additional outreach and support to access programs for which they may be eligible. Our findings contribute to a body of evidence that the Medicaid expansion does more than improve access to health care; it connects eligible low-income individuals to multiple supports. Enrolling in SNAP increases access to food, an important social determinant of health, and an investment in population health for states.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (States with Medicaid Expansion and SNAP)

Population of Focus: Adults/families under 138 percent of the federal poverty level on Medicaid

Sample Size: 414,000 individuals

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Medicaid, NATIONAL, PAYER

Intervention Description: To estimate the effects of Children's Health Insurance Reauthorization Act (CHIPRA), a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization, and health outcomes among immigrant children.

Intervention Results: We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: -11.25, -1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state-funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA.

Conclusion: CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low-income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state-funded coverage. However, we found evidence of crowd-out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well-being of immigrant children but other investments are still needed.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: Medicaid expansion after implementation of the Affordable Care Act (ACA)

Intervention Results: "Income eligible" women had approximately a 5.0 percentage point increased likelihood of both a postpartum visit and use of long-acting reversible contraceptives. Women who entered Ohio Medicaid in the "pregnancy eligible" category had a 7.7 percentage point increase in the probability of remaining continuously enrolled 6 months postpartum relative to those entering as income eligible. However, there was no significant change in postpartum visit attendance in the latter group."

Conclusion: Ohio's ACA Medicaid expansion was associated with a significant increase in the probability of women's continuous enrollment in Medicaid and use of long-acting reversible contraceptives through 6 months postpartum.

Study Design: Retrospective cohort study

Setting: Birth settings where Medicaid is accepted

Population of Focus: Pregnant and postpartum women in Ohio who had both a Medicaid birth and 6-month postpartum period between January 2011 and June 2013 or between November 2014 and December 2015, when the ACA Medicaid expansion was implemented in that state.

Sample Size: 170787

Age Range: ≥19

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: The study analyzed the impact of Ohio's Medicaid expansion under the Affordable Care Act on continuous enrollment and use of covered services postpartum, including postpartum visit attendance, receipt of contraceptive counseling, and use of contraceptive methods.

Intervention Results: Women who entered Ohio Medicaid in the pregnancy eligible category had a 7.7 percentage point increase in the probability of remaining continuously enrolled 6 months postpartum relative to those entering as income eligible. Income eligible women had approximately a 5.0 percentage point increased likelihood of both a postpartum visit and use of long-acting reversible contraceptives. Pregnancy-eligible women had a significant but smaller (approximately 2 percentage point) increase in the likelihood of long-acting reversible contraceptive use.

Conclusion: Ohio's ACA Medicaid expansion was associated with a significant increase in the probability of women's continuous enrollment in Medicaid and use of long-acting reversible contraceptives through 6 months postpartum. Together, these changes translate into decreased risks of unintended pregnancy and short interpregnancy intervals.

Study Design: Retrospective cohort

Setting: Ohio (statewide)

Sample Size: 172862 women

Age Range: 15-44 Women of childbearing age)

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Expanded Insurance Coverage,

Intervention Description: Maternal coverage and care use were compared among women with family incomes 100% to 138% of the federal poverty level (FPL) residing in 10 Medicaid expansion sites (exposure group) who gained Medicaid eligibility under the Affordable Care Act and in 5 nonexpansion sites (comparison group) who gained marketplace eligibility before (2011-2013) and after (2015-2018) insurance expansion implementation.

Intervention Results: Medicaid eligibility relative to marketplace eligibility was associated with significantly increased Medicaid coverage (20.3 percentage points), decreased private insurance coverage (−10.8 percentage points), and decreased uninsurance (−8.7 percentage points) in the preconception period. It was also associated with increased postpartum Medicaid (17.4 percentage points) and increased adequate prenatal care (4.4 percentage points) but not with significant changes in early prenatal care, postpartum checkups, or postpartum contraception.

Conclusion: In this cohort study, eligibility for Medicaid was associated with increased Medicaid, lower preconception uninsurance, and increased adequate prenatal care use. The lower rates of preconception uninsurance among Medicaid-eligible women suggest that women with low incomes were facing barriers to marketplace enrollment, underscoring the potential importance of reducing financial barriers for the population with low incomes.

Study Design: Cohort study

Setting: 10 Medicaid expansions states; 5 non-expansion states

Population of Focus: Women with low incomes

Sample Size: 11432

Age Range: >18

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, Medicaid

Intervention Description: Young adults historically have had the highest uninsured rates among all age groups. In 2014, in addition to Medicaid expansion for adults with low income (≤133% FPL) through the ACA, Massachusetts also extended eligibiligy for children (≤150% FPL) to beneficiaries aged 19 to 20 years. This study examined whether Medicaid expansion in Massachusetts changed coverage continuity for child Medicaid enrollees entering young adulthood. Data from the Massachusetts All-Payer Claims Database (2012 to 2016) was used to compare coverage for Medicaid beneficiaries turning age 19 years before and after Medicaid expansion. Monthly coverage was examined for each cohort for 3 years as beneficiaries aged from 18 and 19 years to 19 and 20 years to 20 and 21 years. Analyses were performed between November 1, 2020, and May 12, 2022. In each year, the likelihood of being uninsured or having Medicaid, employer-sponsored insurance, or individual commercial coverage for 3 or more months was examined along with the likelihood of having continuous Medicaid enrollment for 12 or more and 24 or more months.

Intervention Results: In this cohort study of 41,247 young adults, Medicaid enrollees who turned 19 after or before Medicaid expansion were significantly less likely to have 3 or more months without insurance coverage at ages 18 to 19 and 19 to 20 years and more likely to have continuous Medicaid coverage for24 or more months. Differences in the likelihood of having 3 or more uninsured months diminished at ages 20 to 21 years, when both groups had access to Medicaid (i.e., in calendar years 2014 for the preexpansion cohort and 2016 for the postexpansion cohort). The combination of Federal and state Medicaid expansions -- expanding Medicaid to lower-income adults and increasing the age threshold for child Medicaid eligibility -- was associated with reductions in insurance disruptions and coverage gaps among child Medicaid enrollees entering young adulthood.

Conclusion: In this cohort study of young adults in Massachusetts, the combination of expanding Medicaid to lower-income adults and increasing the age threshold for child Medicaid eligibility was associated with reduced likelihood of becoming uninsured among Medicaid enrollees entering adulthood.

Study Design: Cohort study

Setting: Policy (Medicaid expansion in Massachusetts)

Population of Focus: Young adults, 18-20 yr olds

Sample Size: 41,247 young adults

Age Range: 18-20 year olds

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, STATE

Intervention Description: Our objective was to test whether these training requirements were associated with higher rates of POHS for Medicaid-enrolled children <6 years.

Intervention Results: Five or more years after policy enactment, the probability of a child receiving POHS in medical offices was 10.7 percent in states with training requirements compared to 5.0 percent in states without training requirements (P = 0.01). Findings were similar when receipt of any POHS in medical or dental offices was examined 5 or more years post-policy-enactment (requirement = 42.5 percent, no requirement = 33.6 percent, P < 0.001).

Conclusion: Medicaid policies increased young children's receipt of POHS and at higher rates in states that required POHS training. These results suggest that oral health training for nondental practitioners is a key component of policy success

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Expanded Insurance Coverage,

Intervention Description: The expansion of Medicaid under the Affordable Care Act (ACA) in Colorado in 2013-2015, compared with the state of Utah, which did not expand Medicaid.

Intervention Results: Before Medicaid expansion, the mean number of postpartum outpatient visits in Medicaid was higher in Colorado than in Utah. After expansion, the number of visits increased in Colorado and decreased in Utah, resulting in a 17.3 percent increase in outpatient utilization relative to the baseline rate in Colorado, or 0.52 additional Medicaid-financed visits in the six months after delivery, compared to women in Utah. Utilization increases were significantly greater among women who experienced severe maternal morbidity at the time of their deliveries. Among these women, Colorado’s expansion was associated with 1.3 Medicaid-financed postpartum outpatient visits compared to 0.5 visits among women without severe maternal morbidity, a relative increase of 46.3 percent from Colorado’s baseline mean

Conclusion: After Medicaid expansion in Colorado but not Utah, new mothers in Utah experienced higher rates of Medicaid coverage loss and accessed fewer Medicaid-financed outpatient visits during the six months postpartum, relative to their counterparts in Colorado. The effects of Medicaid expansion on postpartum Medicaid enrollment and outpatient utilization were largest among women who experienced significant maternal morbidity at delivery. These findings provide evidence that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.

Study Design: Two-state claims-based analysis of the effect of Medicaid expansion on postpartum Medicaid coverage and use of postpartum outpatient care

Setting: Birth settings where Medicaid is accepted

Population of Focus: Women who had live births paid for by Medicaid during the period January 2013-June 2015 in Colorado and Utah.

Sample Size: 25,805 deliveries from 24,528 women in Utah and 44,647 deliveries from 42,144 women in Colorado.

Age Range: ≥19

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Outreach (caregiver), PROVIDER/PRACTICE, POPULATION-BASED SYSTEMS, STATE, Medicaid Reform, Education/Training (caregiver), Provider Training/Education

Intervention Description: This study aimed to determine the Washington State's Access to Baby and Child Dent stry (ABCD) Program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge.

Intervention Results: Children in the ABCD program had a mean of 10.27 preventive dental services compared to 0.24 among children not in the ABCD program (p=0.00).

Conclusion: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

Study Design: QE: nonequivalent control group

Setting: Spokane County in WA

Population of Focus: Children aged 12-36 months enrolled in Medicaid as of August 31, 1997

Data Source: Parent survey

Sample Size: Intervention (n=228) Control (n=237)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Policy/Guideline (State), Medicaid,

Intervention Description: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-in-difference modeling. All analyses controlled for household, parent, child, and local area characteristics that could affect insurance status

Intervention Results: Expansions increased parental coverage by 2.5 percentage points and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents’ insurance. Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. The most effective expansions for parental insurance coverage were those for traditional Medicaid coverage without premiums and for special subsidized plans that subsidized costs for individuals to purchase state-sponsored plans. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Conclusion: Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Study Design: Cross-sectional analysis of data

Setting: Policy (States)

Population of Focus: Parents and Children

Sample Size: 19 expansion states (representing 28 expansions) and 22 control states without a parental expansion during the study period

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Expanded Insurance Coverage

Intervention Description: The evaluation included a large survey conducted in 2012 of CHIP enrollees and disenrollees in the 10 states, and Medicaid enrollees and disenrollees in three of these states. It also included case studies conducted in each of the 10 survey states in 2012 and a national telephone survey of CHIP administrators conducted in early 2013. Data from the Current Population Survey and the American Community Survey were analyzed to document national coverage trends from 1997 to 2012.

Intervention Results: Together with Medicaid, CHIP has helped fuel a decline in the number of uninsured children from 11.4 million (15 percent of children) in 1997 to 6.6 million (9 percent of children) in 2012. As of March 2014, 8.13 million children were enrolled in CHIP at some point in FFY 2013.

Conclusion: The evaluation found CHIP to be successful in nearly every area examined. CHIP succeeded in expanding health insurance coverage to the population it is intended to serve, particularly children who would otherwise be uninsured, increasing their access to needed health care, and reducing the financial burdens and stress on families associated with meeting children’s health care needs. These positive impacts were found for children and families in states with different CHIP program structures and features, across demographic and socioeconomic groups, and for children with different health needs. Medicaid and CHIP have worked as intended to provide an insurance safety net for low-income children during economic hard times. Awareness of both Medicaid and CHIP was high among low-income families, most newly enrolling families found the application process at least somewhat easy, and the vast majority of children remained enrolled through the annual renewal period. The evaluation also identified a few areas where there is room for improvement. One in four children in CHIP had some type of unmet need, and although most CHIP enrollees received annual well-child checkups, fewer than half received key preventive services such as immunizations and health screenings during those visits, and fewer than 40 percent had afterhours access to a usual source of care provider. While most CHIP enrollees received annual dental checkups, a significant share of them did not get recommended follow-up dental treatment. There is also room for improvement in reducing the percentage of children who cycle off and back on to Medicaid and CHIP, and reducing gaps in coverage associated with moving between Medicaid and separate CHIP programs. And while participation rates have grown to high levels in most states, further effort could be targeted to the 3.7 million children who are eligible for Medicaid or CHIP but remain uninsured

Study Design: Survey

Setting: National Level and Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Medicaid

Intervention Description: The Massachusetts Medicaid Buy-In program, called MassHealth CommonHealth, allows families of children with disabilities to buy into the state’s Medicaid program to cover more services and to defray costs that private insurance does not cover. Children with disabilities who do not have other insurance can use the program as their sole insurance; Children with disabilities who have other insurance can use the program as a secondary payer to supplement coverage and reduce families’ out-of-pocket costs due to the deductible, co-payments, and coinsurance for the child. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Intervention Results: This study suggests that the MassHealth CommonHealth Buy-In program improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Parents reported that this increased access resulted in improvements in their child’s health or functioning, reduced stress on the parents and families, and reduced financial strain. Overall, many respondents appreciated the CommonHealth program. Despite these benefits, other families reported that they continued to face barriers in access to care for their children with disabilities. They reported difficulty in finding mental health or dental care, as many of these providers (as well as other specialists) did not accept MassHealth. Even with CommonHealth, families still had high out-of-pocket costs due to services that are not covered or high CommonHealth premiums. Families also struggled with complex paperwork requirements. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions. Adopting a Medicaid Buy-In program may be an effective way for other states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Conclusion: Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Study Design: Survey

Setting: Policy (CommonHealth, Massachusetts's Medicaid Buy-In program)

Population of Focus: Parents and caregivers of Massachusetts children with disabilities enrolled in CommonHealth

Data Source: Survey data

Sample Size: 615 families

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Public Insurance (State), Care Coordination,

Intervention Description: Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts’s Medicaid Buy-In program. Parents and caregivers (n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains—availability, accessibility, accommodation, affordability, and acceptability.

Intervention Results: Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions.

Conclusion: Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

Study Design: Qualitative study

Setting: MassHealth CommonHealth Buy-In program, a Medicaid Buy-In program in Massachusetts

Population of Focus: Parents and caregivers of children with disabilities who are enrolled in the MassHealth CommonHealth Buy-In program in Massachusetts

Sample Size: 615 parents and caregivers whose children were enrolled in CommonHealth

Age Range: Children and youth ages 0-18 years and their adult parents and caregivers

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Provider Training/Education,

Intervention Description: The intervention involved the implementation of an Immediate Postpartum LARC Program at a large, urban, tertiary medical center in St. Louis, Missouri, in preparation for the Missouri Medicaid reimbursement policy change in October 2016. This program included placing levonorgestrel and copper IUDs and the etonogestrel implant on hospital formulary, stocking the devices on Labor and Delivery and Postpartum for ease of access, and providing educational talks and hands-on training for healthcare providers involved in deliveries at the institution.

Intervention Results: A total of 6,233 eligible patients delivered during the study period: 3105 before and 3128 after the change in reimbursement for immediate postpartum LARC. Patients delivering after the policy change were more likely to be Hispanic, have commercial insurance or be uninsured, and have a BMI >30. Placement of immediate postpartum LARC increased from 0.7% pre- to 9.7% postpolicy change (aOR 15.6; 95% CI 10.1-24.2). In our stratified analysis, immediate postpartum LARC uptake increased for patients with Medicaid (aOR 15.8; 95% CI 9.9-25.4) and commercial insurance (aOR 9.7; 95% CI 3.0-31.8).

Conclusion: The change in Missouri Medicaid reimbursement for placement of immediate postpartum LARC had systemic impact with an increase in postpartum LARC uptake in all patients, regardless of insurance provider.

Study Design: Retrospective cohort

Setting: Barnes-Jewish Hospital (large academic medical center) St Louis, Missouri

Sample Size: 6233 eligible patients, 3105 patients delivered before the policy changes, 3128 patients delivered after

Age Range: Not stated; Mean age for pre policy group was 27.4 years, mean age for post policy change group was 27.9

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid,

Intervention Description: None

Intervention Results: None

Conclusion: Reductions in racial disparities in maternal mortality will ultimately require transforming care across the perinatal continuum, of which postpartum care improvement is a significant component. Other proposed solutions—including improved maternal death reporting, sustainable support for perinatal quality collaboratives and maternal mortality review committees, increased pregnancy and postpartum support (e.g., doulas, patient navigators, breastfeeding peer counselors, home visits, and case management), pregnancy-centered medical homes, and implicit bias training—have been well characterized in the literature.7 Increased access to postpartum health care via Medicaid extension could allow safer birth spacing via improved access to contraception, increased provision of mental health care, improved access to medication-assisted treatment and recovery services, and longer follow-up for medical complications that occur during pregnancy as well as chronic diseases.

Study Design: n/a

Setting: n/a

Population of Focus: Women of color

Sample Size: n/a

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Medicaid Reform

Intervention Description: Pregnancy risk assessment monitoring system (PRAMS) data (2014–2015) and the Medicaid-SCHIP state dental association (MSDA) national profiles (2014–2015) were used in this study. The study sample included 16,612 Medicaid-enrolled women, for a weighted number of 965,046 women from 26 states and New York City. State Medicaid dental coverage was categorized into (1) no coverage for the dental cleaning, (2) coverage for dental cleaning and fillings, (3) extended dental coverage. The adjusted prevalence ratios (aPR) for dental visits for cleaning during pregnancy were examined by Medicaid dental coverage level.

Intervention Results: Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). Medicaid-enrolled women in states with extended dental coverage were more likely to visit dentists for cleaning during pregnancy when adjusted for other sociodemographic variables and adequacy of prenatal care. A similar pattern of association was observed for a dental visit to address dental problems during pregnancy.

Conclusion: This study highlights the importance of Medicaid dental coverage for adult pregnant women related to dental service utilization during pregnancy.

Setting: Virginia

Population of Focus: State/Systems

Data Source: Community-based PRAMS data

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: The intervention in this study was the impact of the Medicaid policy change on the initiation of long-acting and reversible contraception (immediate postpartum and postpartum) within key populations. We determined whether immediate postpartum long-acting and reversible contraception use varied by adequate prenatal care (>7 visits), metropolitan location, and medical comorbidities. We also tested the association of immediate postpartum and postpartum long-acting, reversible contraception on interpregnancy interval of less than 18 months.

Intervention Results: Our sample included 187,438 births to 145,973 women. Overall, 44.7% of the sample was white, with a mean age of 25.0 years. A majority of the sample (61.5%) was multiparous and resided in metropolitan areas (79.5%). The odds of receipt of immediate postpartum long-acting and reversible contraception use increased after the policy change (adjusted odds ratio, 1.39, 95% confidence interval, 1.34-1.43). Women with inadequate prenatal care (adjusted odds ratio, 1.50, 95% confidence interval, 1.31-1.71) and medically complex pregnancies had higher odds of receipt of immediate postpartum long-acting and reversible contraception following the policy change (adjusted odds ratio, 1.47, 95% confidence interval, 1.29-1.67) compared with women with adequate prenatal care and normal pregnancies. Women residing in rural areas were less likely to receive immediate postpartum long-acting and reversible contraception (adjusted odds ratio, 0.36, 95% confidence interval, 0.30-0.44) than women in metropolitan areas. Utilization of immediate postpartum long-acting and reversible contraception was associated with a decreased odds of a subsequent short interpregnancy interval (adjusted odds ratio, 0.62, 95% confidence interval, 0.44-0.89).

Conclusion: Women at risk of a subsequent pregnancy and complications (inadequate prenatal care and medical comorbidities) are more likely to receive immediate postpartum long-acting and reversible contraception following the policy change. Efforts are needed to improve access in rural areas.

Study Design: Retrospective cohort

Setting: South Carolina (state wide)

Sample Size: 187438 births from 145973 women

Age Range: 18-34

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Expanded Insurance Coverage, PAYER

Intervention Description: We examined the effects of California's expansion on noncitizen children's uninsurance rates and sources of coverage, using data from the 2012-18 American Community Survey.

Intervention Results: California's expansion was associated with significant increases of about 9 and 12 percentage points in any coverage and public coverage, respectively. The estimated increase in any coverage translates to a 34 percent decline in the uninsurance rate relative to the preexpansion rate among noncitizen children (26 percent). Counties with an existing program to reduce children's uninsurance rates experienced an increase in coverage earlier than those without a program in effect before the statewide expansion.

Conclusion: The estimated increase in any coverage translates to a 34 percent decline in the uninsurance rate relative to the preexpansion rate among noncitizen children (26 percent). Counties with an existing program to reduce children's uninsurance rates experienced an increase in coverage earlier than those without a program in effect before the statewide expansion.

Intervention Components (click on component to see a list of all articles that use that intervention): Expanded Insurance Coverage, Medicaid, PAYER

Intervention Description: We use the 2016 to 2020 National Survey of Children's Health (NSCH) to estimate the effects of Medicaid expansions through the Affordable Care Act (ACA) for parents on child health insurance coverage, parents' employment decisions due to child health, and family health-related financial well-being.

Intervention Results: We find that these expansions were associated with increases in children's public health insurance coverage by 5.5 percentage points and reductions in private coverage by 5 percentage points. We additionally find that parents were less likely to avoid changing jobs for health insurance reasons and children's medical expenses were less likely to exceed $1000. We find no evidence that the expansions affected children's dual coverage and uninsurance. Our estimates are robust to falsification and sensitivity analyzes.

Conclusion: Our findings also suggest that benefits on children's medical expenses are concentrated in the families with the greatest financial need.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: Expanded Medicaid eligibility

Intervention Results: Expanded Medicaid eligibility was associated with increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care because of cost, heavy drinking, and binge drinking. Expansion was associated with reduced heavy drinking and binge drinking.

Conclusion: Expanded Medicaid eligibility was associated with increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care because of cost, heavy drinking, and binge drinking.

Study Design: Data collected from the Behavioral Risk Factor Surveillance System (BRFSS) survey.

Setting: Medicaid expansion states

Population of Focus: Low income women of reproductive age

Sample Size: States the expanded Medicaid by Jan 1, 2014 (38 stages plus Washington, DC)

Age Range: 18-44

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: The authors conducted a study of dental services used by women of childbearing age who were enrolled in Medicaid in Oregon during the early 2000s, a period of reform during which health care coverage was expanded.

Intervention Results: Before the intervention, the adjusted proportion of pregnant women with a dental service claim was 0.36. After the intervention, the proportion of pregnant women with a dental service claim declined to 0.22 (p<0.001).

Conclusion: Dental care is important for maternal and child health. However, utilization is unlikely to improve without changes in Medicaid and the dental care delivery system.

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: Medicaid eligibility expansion in expansion vs. non expansion states

Intervention Results: Medicaid expansion was associated with increased receipt of effective postpartum contraception use, preconception health ocunseling, and daily folic acid intake among low-income women with a recent live birth

Conclusion: Medicaid eligibility expansion under ACA associated with positive changes in certain preconception health indicators among low income women, including increased receipt of preconception health counseling, daily folic acid intake, and effective postpartum contraception use.

Study Design: Quasiexperimental

Setting: USA (across 8 Medicaid expansion and 5 nonMedicaid expandion states)

Sample Size: No specific number provided- covered 13 states (8 expansion, 5 nonexpansion)

Age Range: 20-44

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Medicaid Reform

Intervention Description: Researchers used pooled cross-sectional data from six cycles of the Virginia Pregnancy Risk Assessment Monitoring System on women aged ≥21 years. Using logistic regression models and a difference-in-difference design, researchers compared the effects of policy implementation on dental insurance and utilization between pre-policy (2013–2014) and post-policy period (2016– 2019) among women enrolled in Medicaid (treatment, N = 1,105) vs. those with private insurance (control, N = 2,575).

Intervention Results: Among Medicaid-enrolled women, the report of dental insurance (71.6%) and utilization (37.7%) was higher in the post-period compared to their pre-period (44.4% and 30.3%, respectively) estimates. Adjusted analyses found that Medicaid- enrolled women had a significantly greater change in the probability of reporting dental insurance in all post-period years than women with private insurance. In 2019, there was a 16 percentage point increase (95% CI=0.05, 0.28) in the report of dental insurance and a 17 percentage point increase (95% CI=0.01–0.33) in utilization in treatment group compared to controls.

Conclusion: The 2015 pregnancy Medicaid dental benefit increased dental insurance and dental care utilization among Medicaid-enrolled women and reduced associated disparities between Medicaid and privately insured groups.

Setting: Community-based Virginia

Population of Focus: State/Systems

Data Source: Community-based PRAMS data

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: To measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children.

Intervention Results: Relative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas.

Conclusion: Increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Intervention: CT, MD, TX Control: CA, FL, HI, IL, MA, ME, MO, MI, ND, OR, PA, UT, WA, WI

Population of Focus: Children aged 1-17 years eligible for Medicaid

Data Source: 2007 and 2011-2012 National Survey of Children’s Health

Sample Size: NR

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), POPULATION-BASED SYSTEMS, STATE, Medicaid Reform

Intervention Description: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina.

Intervention Results: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000.

Conclusion: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.

Study Design: QE: pretest-posttest

Setting: South Carolina

Population of Focus: Children aged 2-21 years enrolled in Medicaid

Data Source: Medicaid claims

Sample Size: 1998 (n=377,690) 1999 (n=447,069) 2000 (n=504,642)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid, Access, Continuity of Care (Caseload), Community Health Centers

Intervention Description: N/A

Intervention Results: We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs.

Conclusion: HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.

Study Design: We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians.

Setting: Nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care

Population of Focus: HRSA HC patients

Sample Size: ?

Age Range: 18+

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Expanded Insurance Coverage,

Intervention Description: Passage of the Reproductive Health Equity Act, which included coverage for 60 days of postpartum care, including contraception, for the Emergency Medicaid population. In Oregon, this Act went into effect in April 2018.

Intervention Results: Before the policy change, 8.8% of Emergency Medicaid enrollees (1050 women) attended a postpartum visit. After the policy, 55.6% of Emergency Medicaid enrollees (1933 women) attended a postpartum visit. In our adjusted DID model, assuming parallel trends, the policy was associated with an increase in postpartum visit attendance of 40.6 percentage points (95% CI, 34.1-47.1 percentage points; P < .001). Assuming differential trends, the policy was associated with an increase in postpartum visit attendance of 47.9 percentage points (95% CI, 41.3-54.6 percentage points; P < .001)

Conclusion: These findings suggest that expanding Emergency Medicaid benefits to include postpartum care is associated with significant improvements in receipt of postpartum care and contraceptive use.

Study Design: Cohort study and difference-in-difference analysis

Setting: Birth settings where Medicaid is accepted

Population of Focus: Immigrant women eligible for emergency Medicaid in Oregon

Sample Size: 27,667 live births among 23,971 women

Age Range: <20--≥35

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: We enrolled patients in a single-blinded, one-to-one, randomized, controlled trial to assess the impact of enhanced family planning counseling immediately after a viable preterm birth in the inpatient setting. Participants received either structured counseling with an emphasis on LARC by a family planning specialist (intervention) or routine postpartum care (control). We followed participants to the primary outcome of LARC use 3 months postpartum.

Intervention Results: We followed 121 participants for 3 months. Primary outcome data were available for 119 participants (61 intervention, 58 control). We found no demographic differences between the groups. Participants in the intervention group were significantly more likely to use LARC at 3 months postpartum compared with controls (51% vs. 31%; p < .05). For every six women who received the counseling intervention, one additional woman was using a LARC method at 3 months.

Conclusion: After a preterm birth, brief LARC-focused, structured counseling before hospital discharge significantly increased LARC method use at 3 months postpartum.

Study Design: Retrospective cohort

Setting: Oregon and South Carolina

Sample Size: 27677 births; 23971 women

Age Range: 15-44

Intervention Components (click on component to see a list of all articles that use that intervention): Public Insurance (State), Policy/Guideline (State), Medicaid Reform,

Intervention Description: The study aimed to examine whether this health reform was associated with reduced uninsurance and greater access to care for children at one and five years post-reform. The health reform implemented in Massachusetts, also known as Chapter 58, aimed to provide near-universal health insurance coverage to the state's residents. The reform was signed into law in 2006 and required all residents to have health insurance or face penalties. The reform also expanded Medicaid and created a state-run health insurance exchange, the Health Connector, to provide affordable health insurance options to individuals and small businesses. The reform also included subsidies to help low-income individuals and families afford health insurance.

Intervention Results: Compared to other New England states, Massachusetts's enactment of the individual mandate, Medicaid expansion, and essential benefits was associated with trends at 5 years post-reform toward lower uninsurance for children overall (DD = - 1.1, p-for-DD = 0.05), increased access to specialty care (DD = 7.7, p-for-DD = 0.06), but also with a decrease in access to preventive care (DD=-3.4, p-for-DD = 0.004). At 1 year post-reform, access to specialty care improved for children newly-Medicaid-eligible (DD = 18.3, p-for-DD = 0.03).

Conclusion: Adult-oriented health reforms may have reduced uninsurance and improved access to some types of care for children in Massachusetts. Repealing the ACA may produce modest detriments for children.

Study Design: Difference in difference analysis

Setting: State (Massachusetts)

Population of Focus: CSHCN in Massachusetts

Sample Size: 34,943 children (5,760 children in Massachusetts, 28,183 children in comparison New England states)

Age Range: 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: Providing long-acting reversible contraception (LARC), particularly in the immediate postpartum period, is one strategy to meet contraceptive needs. This practice may also prevent unintended and short interpregnancy interval pregnancies. In recent years, state Medicaid programs have implemented reimbursement policies for LARC use in the inpatient setting. The purpose of this study was to assess the uptake of inpatient postpartum LARCs at a large urban hospital with a sizable Medicaid population, before and after policy implementation.

Intervention Results: In the 3-year study period, 2091 LARC insertions occurred, of which 700 (33.5%) were inpatient postpartum, 429 (20.5%) outpatient postpartum, and 962 (46.0%) interval. After policy implementation, inpatient postpartum LARC insertions increased from 2.6 per 100 deliveries to 16.8 per 100 deliveries. Significant differences in uptake were seen in Black and Hispanic populations. The number of outpatient postpartum LARCs remained stable and tubal sterilizations decreased.

Conclusion: Implementation of reimbursement policies contributed to a sharp uptake of inpatient postpartum LARCs. Improved access to effective, reversible contraception could reduce the number of unplanned and short interpregnancy interval pregnancies, ultimately lowering rates of maternal morbidity and mortality.

Study Design: Retrospective cohort

Setting: Grady Health System (safety net hospital), Atlanta, Georgia

Sample Size: 2091 LARC insertions

Age Range: No specific age range given, age blocks were under 20, 20-29, 30-39, and over 40

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform,

Intervention Description: The intervention in this study was a Medicaid policy change in South Carolina that provided separate reimbursement for immediate postpartum LARC insertion.

Intervention Results: The results of the study indicated that the Medicaid payment policy change in South Carolina was associated with increased use of highly effective methods of contraception among adolescents, particularly in the form of immediate postpartum LARC. However, the policy change did not lead to a significant change in the rates of use of highly effective methods among women overall

Conclusion: The study concluded that while the Medicaid payment policy change in South Carolina successfully increased the use of highly effective methods of contraception, particularly immediate postpartum LARC, among adolescents, it did not lead to a significant change in the overall rates of use of highly effective methods among women. The findings also highlighted the uneven adoption of immediate postpartum LARC across healthcare providers, with the majority of facilities providing this option to only a small percentage of women.

Study Design: Retrospective cohort

Setting: South Carolina (statewide)

Sample Size: 154163 total births

Age Range: 12/1/1950

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Expanded Insurance Coverage,

Intervention Description: Medicaid extended beyond 60 days postpartum for those with an income below 138% of the FPL

Intervention Results: Medicaid expansion in Arkansas was associated with a 27.8 (95% CI, 26.1-29.5) percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 (95% CI, 0.7-1.1) during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 (95% CI, 3.9-8.7) percentage points before expansion to −2.0 (95% CI, −2.8 to −1.2) percentage points after expansion. However, disparities in outpatient care between Black and White individuals persisted after Medicaid expansion (preexpansion difference, 0.4 [95% CI, 0.2-0.6] visits; postexpansion difference, 0.5 [95% CI, 0.4-0.6] visits).

Conclusion: In this cohort study with a difference-in-differences analysis of 60 990 childbirths, Medicaid expansion was associated with higher rates of postpartum coverage and outpatient visits and lower racial and ethnic disparities in postpartum coverage. However, disparities in outpatient visits between Black and White individuals were unchanged. Additional policy approaches are needed to reduce racial and ethnic disparities in postpartum care.

Study Design: Quasi-experimental cohort study with a difference-in-differences analysis

Setting: Birth settings where Medicaid is accepted

Population of Focus: Low-income postpartum women eligible for expanded Medicaid

Sample Size: 60,990 childbirths

Age Range: 19-50

Intervention Components (click on component to see a list of all articles that use that intervention): Medicaid Reform, Expanded Insurance Coverage,

Intervention Description: Expansion of Medicaid under the Families First Coronavirus Response Act (FFCRA) of 2020 which required that state Medicaid programs provide continuous coverage to enrollees through the end of the COVID-19 public health emergency (PHE)

Intervention Results: Within 90 days of delivery, postpartum services utilization was comparable Post- Families First Coronavirus Response Act (FFCRA) vs. Pre-FFCRA. After 90 days postpartum, however, Post-FFCRA utilization was 2-fold higher than Pre-FFCRA utilization (6.7 vs. 3.2%, respectively. The same patterns were observed when examining all outpatient services utilization. Although overall outpatient services utilization decreased after 90-days postpartum, Post-FFCRA utilization was 2–5-fold higher than Pre-FFCRA utilization through the end of the first-year postpartum, with 17.7% of Post-FFCRA women receiving outpatient care between 91- and 182-days and 17.9% between 183- and 365-days postpartum, vs. 3.4 and 8.8% for Pre-FFCRA women, respectively.

Conclusion: Our analysis demonstrates that the FFCRA's continuous coverage requirement is associated with a sustained increase in preventive services utilization throughout the first-year postpartum. Other benefits include increased utilization of contraceptive services, decreased incidence of short interval pregnancies, and increased utilization of MBH/SUD services.

Study Design: Retrospective cohort study and secondary analysis

Setting: Parkland Community Health Plan (a Texas Medicaid Health Maintenance Organization)

Population of Focus: Singleton postpartum women enrolled in Medicaid

Sample Size: 3,465 Pre-FFCRA and 5,411 Post-FFCRA deliveries

Age Range: 14-48