Postpartum Transitions to Primary Care among Women Enrolled in State Medicaid Programs Experiencing Chronic Disease During Pregnancy

Transitioning to primary care during the post/intrapartum period is important for long-term disease prevention and management for women experiencing chronic conditions like diabetes during pregnancy. This issue is particularly salient among women of lower incomes who lose Medicaid coverage postpartum as well as rural women who face additional barriers in accessing health care. However few studies have examined postpartum transitions for women enrolled in state Medicaid programs and none have examined transitions among rural women facing historical barriers in accessing primary care despite continued insurance coverage. This project addresses this research gap and multiple MCHB Strategic Research issues including incorporating social determinants of health and health equity frameworks into research; improving the quality and accessibility of health and community resources and services for mothers children and families especially those of underserved MCH populations; improving access to adequate health insurance; and identifying the service system and infrastructure changes that are needed at the community state and/or national levels to maximize health outcomes as they apply to different maternal and child health populations. Goals and Objectives: The goal of this project is to advance health equity for childbearing women of lower incomes and women residing in rural communities by examining potential disparities in primary care transitions including the immediate postpartum visit among women enrolled in Medicaid experiencing gestational diabetes mellitus (GDM) during pregnancy. Specific objectives include: 1. Examining geographic differences (rural/urban) in immediate postpartum visits and diabetes glucose screening within 90 days of delivery among women with GDM enrolled in state Medicaid programs. 2. Examining primary care transitions within 12 months and the extent to which transitions are experienced equitably by geography (rural/urban) among continuously insured women in state Medicaid programs. Proposed Datasets and Target Population: The Transformed Medicaid Statistical Information System (T-MSIS) for the years 2016-2020 will be used to examine the proposed research objectives. T-MSIS is a data repository of Medicaid and Children's Health Insurance Program (CHIP) claims data from U.S. states and is the largest national resource of Medicaid beneficiary information. The study population includes women between the ages of 20-45 enrolled in State Medicaid programs giving birth in 2016-2019 with service receipt followed for up to 1-year postpartum (2020). Products: Two manuscripts one issue brief and a 1-page leave behind summarizing study findings will be produced. Findings will be disseminated through academic channels including journals and conference abstracts. Other products more conducive for non-academic consumption will be produced and distributed to program and policy outlets including the National Rural Health Association (NRHA) and The Association of Maternal & Child Health Programs (AMCHP). Evaluation: A detailed research implementation plan with stated goals and objectives has been developed and will be used to evaluate progress in completing the proposed project and measuring the potential impact of research findings.