Project Summary/Abstract Rates of severe maternal morbidity (SMM) and mortality continue to rise in the US and have been exacerbated during the pandemic. The significant racial inequities in SMM and mortality are a public health crisis and are a result of historical and contemporary structural and social determinants including institutional and societal policies. Integrating a racial equity lens to Medicaid policy interventions is a promising strategy for addressing the long-standing racial inequities in SMM and broadly in maternal health. In the state of Pennsylvania, Medicaid is implementing policy interventions that explicitly focus on Black populations. Three policy interventions will be the focus of this study: the equity incentive payment program, the equity- focused obstetric care bundled payment model and the reimbursement program for doula services. These policy interventions are critical but will not successfully address racial inequities without a multi-disciplinary, community engaged process that involves a constant critical analysis for racial equity in the development and implementation of these policies. We will conduct a multi-armed intervention study to assess the effects of the healthcare quality interventions (equity incentive payment and equity-focused obstetric care bundle) and the healthcare quality + doula care program vs. standard care. Because these interventions are prospectively assigned to all PA Medicaid beneficiaries, we will compare within-state changes pre-post interventions, as well as comparing changes in outcomes pre-post interventions among PA Medicaid beneficiaries relative to Medicaid beneficiaries residing in similar states. Our multidisciplinary team includes researchers and leaders across multiple academic institutions, the Medicaid Research Center, Healthy Start Inc, the Pennsylvania Doula Commission and the Maternity Care Coalition. Our study aims to: 1) estimate the effect of Medicaid healthcare quality interventions on SMM, 2) estimate the effect of Medicaid healthcare quality interventions + doula care, 3) Assess Medicaid beneficiaries’ experiences in receiving services and the potential impact of integration of doula services and equity practices. Our central hypothesis is that SMM rates will decline among Black populations after interventions relative to people of other racial groups. This work will advance public health and health policy by implementing innovative methods to engage with Medicaid beneficiaries who are affected by health equity policies and provide quantitative estimates of the effects of health equity policy interventions on outcomes among Black pregnant and parenting people. Results from this study will inform state and federal health policymakers considering structural policy interventions within Medicaid as a vehicle for addressing racial equity.

Narrative This study is designed to investigate the effects of structural inventions, such as equity-focused Medicaid polices, on severe maternal morbidity and mortality and maternal health. The proposed study will 1) estimate the effect of Medicaid healthcare quality interventions on SMM, 2) estimate the effect of Medicaid healthcare quality interventions + doula care, 3) Assess Medicaid beneficiaries’ experiences in receiving services and the potential impact of integration of doula services and equity practices. The long-term objective is to inform state and federal health policymakers considering structural policy interventions within Medicaid as a vehicle for addressing racial equity