Addressing Maternal Mortality: The Role of Medicaid Expansion and Telehealth in Reducing Disparities
Section I: Health Problem and Research Question
Maternal mortality is a critical and urgent public health issue in the United States, particularly in underserved communities and among racial minorities. The high rates of maternal mortality, especially in rural areas and among Black and Hispanic women, are linked to various systemic inequities, including inadequate access to postpartum care. Studies show that Medicaid is crucial to maternal health, covering many births. However, there are gaps in extending postpartum care and addressing racial and ethnic disparities in maternal outcomes?.
Research Question: How can extending Medicaid postpartum care coverage in underserved communities reduce maternal mortality and improve health equity for Black and Hispanic women?
Rationale: This question was selected because data indicates that many maternal deaths occur during the postpartum period. Extending Medicaid postpartum coverage from 60 days to one year has been shown to improve maternal outcomes by providing continued care for postpartum complications. Focusing on underserved communities and racial minorities is essential as these groups disproportionately suffer from higher maternal mortality rates?.
Section II: Annotated Bibliography
Cohen, J. L., & Daw, J. R. (2021). Postpartum cliffsmissed opportunities to promote maternal health in the United States. JAMA Health Forum,
This article identifies several postpartum cliffs that compromise healthy transitions from pregnancy to parenthood in the US. The authors highlight gaps in patient planning, physician handoffs, insurance coverage, cost sharing, payment models, and quality measurement for postpartum care (Cohen & Daw, 2021). They propose potential solutions, including extending Medicaid coverage, improving care transitions, and developing new quality metrics for postpartum care. This primary source provides a comprehensive overview of systemic issues affecting postpartum care quality and access. The proposed solutions offer promising directions for intervention design and policy changes.
Cross-Barnet, C., Courtot, B., Benatar, S., & Hill, I. (2020). Preeclampsia risk and prevention among pregnant Medicaid beneficiaries. Journal of Health Care for the Poor and Underserved, 31(4), 1634-1647.
This mixed-methods study examined low-dose aspirin (LDA) use to prevent preeclampsia among Medicaid beneficiaries enrolled in the federal Strong Start for Mothers and Newborns II initiative. Cross-Barnet et al. (2020) found many Strong Start participants had risk factors warranting LDA use, but most practices reported inconsistent or non-existent prescribing. LDA use varied across care models, such as birth centers, group prenatal care, and maternity care homes, as well as across different provider types. Additionally, ancillary care team members...
Problem Areas and Gaps in Research
The research reveals that while Medicaid extensions and telehealth interventions can improve maternal health outcomes, there are still gaps in addressing racial and ethnic disparities. Most studies emphasize the need for data to evaluate the effectiveness of these policies in reducing mortality among minority populations. Furthermore, there is limited research on how to scale these interventions across different regions, particularly in rural areas with limited healthcare infrastructure.
References
Cohen, J. L., & Daw, J. R. (2021). Postpartum cliffsmissed opportunities to promote maternal health in the United States. JAMA Health Forum,
Cross-Barnet, C., Courtot, B., Benatar, S., & Hill, I. (2020). Preeclampsia risk and prevention among pregnant Medicaid beneficiaries. Journal of Health Care for the Poor and Underserved, 31(4), 1634-1647.
Haley, J. M., Hinojosa, S., Lacy, L., & Willis, C. (2022). Advancing Maternal Health Equity in Southern States.
Pedersen, S., Zapata, D., & Jones, C. (2023). The Role of Medicaid Policy in…
Shah, L. M., Varma, B., Nasir, K., Walsh, M. N., Blumenthal, R. S., Mehta, L. S., & Sharma, G. (2021). Reducing disparities in adverse pregnancy outcomes in the United States. American heart journal, 242, 92-102.
Sundstrom, B., DeMaria, A. L., Ferrara, M., Meier, S., & Billings, D. (2019). “The closer, the better:” the role of telehealth in increasing contraceptive access among women in rural South Carolina. Maternal and Child Health Journal, 23, 1196-1205.
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