Thread by @DrChelleMD, My first thread-wish me luck! More on why Medicaid expansion is important [...]

My first thread-wish me luck! More on why Medicaid expansion is important for maternal #healthequty

Medicaid covers 25-50% of births in the US and is the largest single-payer of maternity care; Medicaid disproportionately covers low-income women & racial/ethnic minorities. Regarding Medicaid and maternal health, there are two separate/equally important issues.

#1 Expansion of eligibility criteria,"Medicaid expansion". Medicaid coverage lasts up to 60 days postpartum, in non-expansion states, after this time is up, women must requalify for Medicaid as low-income parents; this is harder to do & results in coverage "churn"/ coverage gaps

Medicaid expansion decreases coverage churn, but beyond that does it matter? Some evidence from Gordon et. al to suggest that medicaid expansion may improve coverage stability and

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben">use of Medicaid-financed outpatient care postpartum . …https://www-healthaffairs-org.proxy1.library.jhu.edu/doi/full/10.1377/hlthaff.2019.00547?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&">https://www-healthaffairs-org.proxy1.library.jhu.edu/doi/full/...

But perhaps the most important benefit of Medicaid expansion is demonstrated in study by @eleliason @WHIjournal: Medicaid expansion associated w/

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> maternal mortality by 7.01 maternal deaths per 100,000 live births (p = .002); Effects concentrated among Black mothers.

But perhaps the most important benefit of Medicaid expansion is demonstrated in study by @eleliason @WHIjournal: Medicaid expansion associated w/https://abs.twimg.com/emoji/v2/... draggable=

maternal mortality by 7.01 maternal deaths per 100,000 live births (p = .002); Effects concentrated among Black mothers." title="But perhaps the most important benefit of Medicaid expansion is demonstrated in study by @eleliason @WHIjournal: Medicaid expansion associated w/https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> maternal mortality by 7.01 maternal deaths per 100,000 live births (p = .002); Effects concentrated among Black mothers." class="img-responsive" style="max-width:100%;"/>

But is Medicaid expansion enough? Even in the post ACA era, where many states have expanded Medicaid, women still experience coverage churn ( albeit less than in non-expansion states)
https://www.healthaffairs.org/do/10.1377/hblog20190913.387157/full/">https://www.healthaffairs.org/do/10.137...
Which brings me to #2 extension of benefit coverage time

Currently, Medicaid coverage stops 60 days postpartum. This is not insignificant, in a "Report of 9 Maternal Mortality review committees", 18% of deaths occurred after 42 days postpartum. This varies widely by state. In 2018 Texas reported 56% of deaths AFTER 60 days postpartum.

So there is some clear potential benefit of increasing access during the 1st year postpartum & several states have been working on this, in a recent report @emilyanneck @Health_Affairs gives an overview of the legislative landscape/including federal bills. https://www.healthaffairs.org/do/10.1377/hblog20200203.639479/full/#:~:text=Several%20federal%20bills%20were%20introduced,coverage%20through%2012%20months%20postpartum.&text=This%20legislation%20would%20create%20a,enrolled%20in%20Medicaid%20or%20CHIP.">https://www.healthaffairs.org/do/10.137...

As a researcher focused on maternal health equity, I know that Medicaid expansion is just 1 lever & several more need pulling! Excited about the Black Maternal health #Momnibus act by @Repadams @KamalaHarris @LaurenUnderwood. 9 bills to try & address this maternal health crisis.

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