Dissertation
The Effect of Continuous Postpartum Medicaid Coverage on Medication for Opioid Use Disorder Utilization and Hepatitis C Care Among Persons with Opioid Use Disorder
Abstract
The rate of pregnant persons with opioid use disorder (OUD) during delivery increased 131% from 2010 to 2017. The standard of care for pregnant persons with OUD is treatment with medications for opioid use disorder (MOUD), yet only a third of pregnant persons with OUD receive treatment. The use of MOUD during and after pregnancy reduces poor maternal and child outcomes, such as obstetric complications and low infant birth weight, as well as overdoses, overdose deaths, and maternal mortality. Coinciding with increased opioid use, Hepatitis C virus (HCV) incidence in pregnant people increased 1,458% from 0.34 to 5.3 cases per 1000 pregnancies between 1998-2018. The postpartum period provides an important opportunity for HCV treatment with direct acting antivirals (DAAs), which can cure HCV.
Over 80% of pregnant women with OUD are enrolled in Medicaid, yet 20% with pregnancy-related Medicaid become uninsured within six months postpartum, leading to gaps in insurance coverage and reduced access to care. The Families First Coronavirus Response Act (FFCRA) continuous enrollment provision prevented states from disenrolling Medicaid beneficiaries, including postpartum beneficiaries, from March 2020-March 2023. Medicaid churn among postpartum persons decreased during this time, providing an opportunity to examine the effect of extended postpartum coverage on MOUD retention and HCV care.
The rate of pregnant persons with opioid use disorder (OUD) during delivery increased 131% from 2010 to 2017. The standard of care for pregnant persons with OUD is treatment with medications for opioid use disorder (MOUD), yet only a third of pregnant persons with OUD receive treatment. The use of MOUD during and after pregnancy reduces poor maternal and child outcomes, such as obstetric complications and low infant birth weight, as well as overdoses, overdose deaths, and maternal mortality. Coinciding with increased opioid use, Hepatitis C virus (HCV) incidence in pregnant people increased 1,458% from 0.34 to 5.3 cases per 1000 pregnancies between 1998-2018. The postpartum period provides an important opportunity for HCV treatment with direct acting antivirals (DAAs), which can cure HCV.
Over 80% of pregnant women with OUD are enrolled in Medicaid, yet 20% with pregnancy-related Medicaid become uninsured within six months postpartum, leading to gaps in insurance coverage and reduced access to care. The Families First Coronavirus Response Act (FFCRA) continuous enrollment provision prevented states from disenrolling Medicaid beneficiaries, including postpartum beneficiaries, from March 2020-March 2023. Medicaid churn among postpartum persons decreased during this time, providing an opportunity to examine the effect of extended postpartum coverage on MOUD retention and HCV care.
The specific aims of this dissertation are to: 1) Evaluate the effect of the continuous enrollment provision of the FFCRA on postpartum Medicaid coverage among persons with OUD; 2) Measure MOUD retention among Medicaid-enrolled postpartum persons with OUD pre- and post-FFCRA and assess if the FFCRA continuous enrollment provision increased MOUD retention among postpartum persons with OUD; 3) Measure rates and timing of the HCV Cascade of Care steps postpartum and assess if the FFCRA continuous enrollment provision increased HCV care among postpartum persons with OUD and HCV. The proposed research will use electronic medical record data linked to insurance claims from across the United States, capturing insurance coverage, pharmacy claims, and laboratory test results. Findings will shed light on the potential impacts of extended postpartum Medicaid coverage in states that adopt this option through the American Rescue Plan Act.
