The Effects of Medicaid Policy Interventions on Severe Maternal Morbidity

Rates of severe maternal morbidity (SMM) and mortality continue to rise in the US and have been exacerbated during the pandemic. The significant and high rates of SMM and mortality are a public health crisis and are a result of historical and contemporary structural policies and processes. Medicaid policy interventions is a promising strategy for addressing SMM and maternal health. In the state of Pennsylvania, Medicaid is implementing policy interventions that explicitly focus on maternal and child health. Three policy interventions will be the focus of this study: the Medicaid managed care incentive payment program, the obstetric care bundled payment model, and the reimbursement program for doula services. We will conduct a multi-armed intervention study to assess the effects of healthcare quality interventions (incentive payment and obstetric care bundle) and the healthcare quality + doula care program vs. standard care. Because these interventions are prospectively assigned to all PA Medicaid beneficiaries, we will compare within-state changes pre-post interventions, as well as comparing changes in outcomes pre-post interventions among PA Medicaid beneficiaries relative to Medicaid beneficiaries residing in similar states. Our multidisciplinary team includes researchers and leaders across multiple academic institutions, the Medicaid Research Center, Healthy Start Inc, the Pennsylvania Doula Commission and the Maternity Care Coalition. Our study aims to: 1) estimate the effect of Medicaid healthcare quality interventions on SMM, 2) estimate the effect of Medicaid healthcare quality interventions + doula care, 3) Assess Medicaid beneficiaries’ experiences in receiving services and the potential impact of integration of doula services. Our central hypothesis is that SMM rates will decline among populations at risk after interventions. This work will advance public health and health policy by implementing innovative methods to engage with Medicaid beneficiaries who are affected by policies and provide quantitative estimates of the effects of health policy interventions on outcomes. Results from this study will inform state and federal health policymakers considering system-level policy interventions within Medicaid as a vehicle for improving maternal health.