Research In Practice Blog
Researchers from the Children’s Hospital of Philadelphia have been awarded a $4.3 million R01 grant from the National Institutes of Health (NIH) to address knowledge gaps regarding Medicaid enrollment in early adulthood. They will investigate the links between Medicaid enrollment and birth outcomes.
It’s well understood that the health of women during pregnancy at birth can have lasting effects on women’s health and on their children as they grow up. The results of this new project will provide important evidence to help health systems and Medicaid programs improve the health of women before they become pregnant. This is a crucial step in tackling the high rates of problems at birth and the common health issues seen in children across the United States.
“Chronic diseases, such as diabetes, mental health conditions, and obesity, are on the rise among young adults. As these young adults go on to become parents themselves, we know that health at conception significantly influences pregnancy outcomes for both women and infants. If these conditions are not effectively managed before pregnancy, sometimes called “the preconception period,” they could worsen birth outcomes for the next generation,” said study lead and pediatric primary care physician-researcher Emily F. Gregory, MD, MHS.
Young adults aged 19 to 34 have the highest uninsurance rates in the United States and frequently experience changes in their insurance status, a phenomenon known as churn. Changes in insurance status can be due to administrative barriers to enrollment or to changes in eligibility status. Inconsistent insurance enrollment can have substantial health consequences. Specifically, churn is associated with suboptimal management of chronic disease, interruptions in care, lower self-rated health, and low prenatal care. Unfortunately, for some, uninsurance and churn during early adulthood many mean that women cannot adequately manage their chronic conditions or access preventive care during a time that could be crucial for them to ensure optimal pregnancy health.
For this project, researchers will focus on a key Medicaid demographic: adults who benefited from pediatric Medicaid enrollment. This cohort is particularly likely to rely on Medicaid coverage during pregnancies in early adulthood. With that focus, this work will provide new evidence on how these Medicaid investments impact multigenerational health outcomes.
The project will be led by a team of researchers from Clinical Futures at the Children’s Hospital of Philadelphia, including Emily F. Gregory, MD, MHS, and attending neonatologist and Associate Chief of the Division of Neonatology Scott A. Lorch, MD, MSCE, along with colleagues from the University of Pennsylvania Perelman School of Medicine. Drs. Gregory and Lorch are also Senior Fellows at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and Core Faculty members at Clinical Futures, and PolicyLab, which are Centers of Emphasis within the CHOP Research Institute.
“The idea for this grant grew out of my clinical practice, where I care for many youths with chronic diseases who are aging out of pediatric Medicaid eligibility. Much of my research has focused on birth outcomes and preconception care, and I started to wonder if these youth were going to be able to access the care, they needed to have the healthiest pregnancies possible. It turns out there has not been much work looking at whether these youth continue to be engaged in Medicaid during early adulthood. The research generated by this project will help us gain valuable insights, enabling us to better understand the role of Medicaid in supporting preconception health. By using Medicaid claims from an extended period in early adulthood, we will be able to test whether Medicaid enrollment in this period is associated with birth outcomes. Our main goal is generating evidence that will help health systems and payers set the foundation for healthy pregnancies and lifelong wellness,” Dr. Gregory said.
Dr. Gregory's research centers on maternal-child health and health services use. She has a special interest in the transition period to parenthood and seeks to understand health care access and health behaviors at the level of the mother-infant dyad. Her work aims to support family-wide health and improve pregnancy outcomes for future pregnancies.
Dr. Gregory’s co-investigator on this project, Dr. Scott Lorch, and his team have invested in developing datasets and methodological expertise to conduct research using large-scale Medicaid claims datasets. Dr. Lorch’s research focuses on understanding the root causes of variations in health outcomes and healthcare utilization among high-risk children, particularly those born prematurely. He is particularly interested in the role of local and state policies in the observed variation in outcomes for premature infants, such as the impact of certificate-of-need programs on these outcomes.
Understanding the Knowledge Gap Between Medicaid Enrollment and Health Post-Pregnancy
This five-year longitudinal study builds on the previous research by Drs. Gregory and Lorch on preconception health care and Medicaid. This current study will identify patterns of Medicaid enrollment during early adulthood and investigate whether these patterns are associated with states’ adoption of Medicaid expansion. Researchers will quantify the number of months of Medicaid enrollment and the rate of enrollment churn among individuals aged 19 to 25 years.
The approach leverages two key aspects of Medicaid.
- First, the Affordable Care Act (ACA) encouraged states to raise income thresholds for adult Medicaid eligibility, starting in 2014. This change led to increased enrollment in Medicaid during early adulthood. Because some states implemented this expansion, and some did not, researchers can compare similar individuals in both expansion and non-expansion states. This method allows strong tests of the role of Medicaid in promoting healthy birth outcomes over time.
- Second, high rates of Medicaid enrollment during childhood allow researchers to focus this research on individuals who grew up in low-income households. These individuals are most likely to benefit from Medicaid expansion. Focusing on this cohort will strengthen the analysis because outcomes will be less mixed with those who might be less likely to benefit from the expansion.
Making a Lasting Impact on Women’s Health
This project takes a new approach by looking at Medicaid enrollment for a longer time during early adulthood, rather than just focusing on each pregnancy individually. This approach recognizes that managing health risks over time can play a significant role in improving the outcomes for babies at birth. By supporting women’s health well in advance, clinicians can help ensure healthier pregnancies and happier beginnings for families.