Persistence of a Birth Cohort Effect in the US Among the Adult Homeless Population

A major challenge for Robert Wood Johnson Barnabas Health (RWJBH) primary care practices is managing patients with co-occurring chronic and behavioral health conditions. Integrated behavioral health (IBH) is a solution for improving quality and clinical outcomes for patients with co-occurring behavioral and physical health conditions by embedding behavioral health providers into the primary care setting. This study is a mixed methods, comparative case study using learning health system science to establish the value of IBH at RWJBH, promoting system-wide adoption via three aims: 1) Identify the top critical metrics for establishing the value of IBH; 2) Align the critical metrics with existing datasets at RWJBH practices and build a pilot dashboard; and 3) Assess the preliminary value of IBH in the case study sites. This project is being led by investigators from Rutgers Center for State Health Policy and Rutgers University Behavioral Health Care and is supported by a grant from the Learning Health System Scientist Training and Research in New Jersey (LHS STAR NJ) Research Project Award Program through the U.S. Agency for Healthcare Research and Quality.

Despite high postpartum healthcare needs and high rates of postpartum maternal mortality, traditional pregnancy- related Medicaid coverage ends after 60 days postpartum. Medicaid pays for almost half of all births in the US and disproportionately covers births to the low-income population and people of color. There has recently been increased interest in postpartum Medicaid, including an American Rescue Plan Act (ARPA) option to extend Medicaid one-year postpartum. Prior to this, the March 2020 Families First Coronavirus Response Act (FFCRA) prevented Medicaid disenrollment during the pandemic, thereby extending postpartum Medicaid eligibility. Drawing on Medicaid expertise at the Center for State Health Policy, results from extended postpartum Medicaid eligibility during the FFCRA can inform current postpartum Medicaid policies, including those being implemented under ARPA. Using the Rhode Island All Payer Claims Database, analyses focus on maternal and child coverage and care use changes during the FFCRA, differences by race and ethnicity, and the effects of the COVID-19 pandemic context.

This project is funded under the Robert Wood Johnson Foundation’s research program, “Health Data for Action (HD4A),” which makes valuable data from unique data owners available to researchers to answer important research questions. The goal of the study is to explore the impact of continuous postpartum Medicaid coverage eligibility under the March 2020 Families First Coronavirus Response Act (FFCRA) on postpartum enrollment and health care use. Using T-MSIS TAF data, the study seeks to examine the impact of the FFCRA continuous Medicaid coverage provisions on postpartum Medicaid retention and health care utilization, particularly among racially and ethnically minoritized groups, individuals with severe maternal morbidity, and individuals with Emergency Medicaid. The research team will use TAF data from the 15 included states, aggregated at the state-month level, to examine outcomes for Medicaid enrollees who gave birth between January 2019-June 2021. They will employ rigorous econometric methods to identify the effects of extended postpartum Medicaid eligibility during the FFCRA on postpartum enrollment and health care use. Deliverables will include a project work plan and final narrative. The researchers will also produce paper(s) suitable for publication and present findings at national research meetings and to other stakeholder audiences as appropriate, including policymakers at the federal, state, and local levels and other key stakeholders, as part of the deliverables for this grant.