Established Evidence Results

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): 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 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 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): 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): 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): 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): 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 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 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