In 2014, the state of Ohio will expand Medicaid under the provisions of the Affordable Care Act (ACA), which is expected to reduce the percentage of uninsured low-income women of reproductive age by covering those with incomes at or below 138% of the federal poverty level. In so doing, there is an expectation that the utilization of key health services among pregnant and non-pregnant women of reproductive age will improve and, in turn, that women's health outcomes as well as outcomes related to pregnancy, birth, and infant health will also improve. From a policy perspective, it is vital that we rigorously analyze and understand the penetration of Medicaid policy changes into the target population, the enrolled population's uptake, and utilization of covered services, and ultimately the impact of the policy or specific service utilization on important health outcomes. In order to assess and further improve health care policy and services received by low-income women of reproductive age, the linkage and analysis of integrated data systems are needed. With this application, we propose to accomplish three Specific Aims with the strong and established partners in Ohio, academic collaborators, and the Centers for Disease Control and Prevention (CDC): (1) To iteratively develop and operationalize a research agenda in collaboration with the Ohio Medicaid Agency (OMA), Ohio Department of Health (ODH), Ohio State University (OSU), Ohio Perinatal Quality Collaborative (OPQC), Ohio Collaborative to Prevent Infant Mortality (OCPIM), Ohio Hospital Association(OHA), Emory University, and the CDC in order to evaluate the impact of the expansion of Medicaid on the health of Medicaid- eligible women of reproductive age and their pregnancies and birthed infants; (2) To link Ohio vital records (birth, fetal death, infant death) Medicaid administrative data (eligibility, enrollment, encounter, and claims), hospital discharge data (inpatient, emergency room), and draw from other available survey data sources (including PRAMS, BRFSS, and OMAS) for consecutive years beginning with 2008 by obtaining and maintaining relevant institutional approvals and data sharing agreement;performing the requisite steps for linkage and validity checks upon the linkage;and sharing, summarizing, and reviewing de-identified linked and supporting data among the partners, including academic collaborators and the CDC;(3) To conduct data analyses to answer our collaboratively-specified research questions and contextualize findings; prepare written manuscripts and oral presentations detailing findings;and disseminate reports and presentations to key stakeholders within the state and nationally. The conduct of this work will add important policy-relevant information about the potential of Medicaid expansion to influence health services utilization, behavioral uptake, and key outcomes related to women's and infant's health.

Public Health Relevance

The state of Ohio is choosing to expand Medicaid under the provisions of the Affordable Care Act (ACA), which is expected to reduce the percentage of uninsured low-income women of reproductive age by expanding the Medicaid program to cover those with incomes at or below 138% of the federal poverty level. The state of Ohio, along with its assembled team of state and academic partners, is prepared to engage with the Centers for Disease Control and Prevention to examine health services utilization and health outcomes among low- income women of reproductive age both before and after expansions in Medicaid eligibility using linked data (from vital records, Medicaid, and hospital discharge) as well as population-based surveys that explore the prevalence of key conditions and health services utilization. Ultimately, the proposed work will culminate in the application of rigorous research methodologies and a collaborative approach to explore potential causal associations between the Medicaid expansion, key health services utilization, and improved health and pregnancy outcomes.

National Institute of Health (NIH)
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZDP1-EEO (04))
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Ohio State Department/Job/Family Services
United States
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