PROJECT SUMMARY / ABSTRACT Candidate: Lindsay Admon, MD, MSc is an obstetrician-gynecologist and junior health services researcher focused on improving health outcomes for pregnant and postpartum women. Dr. Admon’s long-term career objective is to become an independent investigator who is deeply committed to advancing maternal health equity in the United States (US) through maternal health policy evaluation. Research Context: Disruptions in insurance coverage during the perinatal period are frequent among the 4 million women giving birth in the US each year and particularly affect low-income, racial and ethnic minority, and rural women as well as those with chronic conditions. The overarching hypothesis of this proposal is that insurance disruptions contribute to adverse maternal and child health (MCH) outcomes. The knowledge generated by this proposal will inform clinical and policy strategies for addressing the maternal health crisis. Candidate’s Background and Achievements: Dr. Admon is an Assistant Professor in Obstetrics & Gynecology at the University of Michigan. She earned a Masters degree in Health and Healthcare Research through the National Clinician Scholar’s Program. To date, she has published 24 original, peer-reviewed research publications, including 15 on which she was the first or senior author. Based on her scientific body of work, she was recently invited to lecture at the Eunice Kennedy Shiver National Institute of Child Health and Human Development’s Workshop “Maternal Mortality in the United States: Future Research Directions.” Career Development Plan: In order to achieve her goals, Dr. Admon will develop new expertise in econometrics and survey methodology, working with Medicaid claims, and understanding Medicaid policy. Dr. Admon’s career development goals will be supported by close mentorship from an interdisciplinary team, advanced didactic coursework, and ongoing guidance in her research. Specific Aims: 1) Measure the association between perinatal insurance disruptions and healthcare utilization and health outcomes for mothers and their children (birth to 60 days postpartum); 2) Characterize association between insurance disruptions and unmet healthcare needs (birth to six months postpartum); and 3) Among low-income mother sin Michigan, examine the associations between new maternal eligibility for Medicaid coverage (60 days to one year postpartum) under Medicaid expansion and maternal and infant enrollment in Medicaid and healthcare utilization among infants during the first year after birth. Deliverables: The proposed aims will contribute to the successful development of two R01 proposals: 1) To further evaluate the role of insurance eligibility and benefit design in supporting the health of pregnant and postpartum women; 2) To conduct a nationwide survey to explore more refine hypotheses on the associations between insurance coverage, unmet healthcare needs, and MCH outcomes during the first year postpartum.

PROJECT NARRATIVE Millions of women in the United States (US) face gaps and transitions (disruptions) in insurance coverage during the preconception, pregnancy, and postpartum periods, which has led to recent state- and federal- legislation proposing perinatal insurance eligibility expansions as a solution for addressing preventable maternal morbidity and mortality in the US. We lack an understanding, however, of 1) the associations between maternal insurance disruptions and maternal and child health (MCH) outcomes and 2) whether prior perinatal insurance expansions have been associated with improved MCH outcomes. Correcting these knowledge gaps is the overarching goal of this proposal, data which we believe will be of great public health importance and inform clinical and policy strategies for improving maternal health in the US.