Examining the Impact of Ohio’s Medicaid Expansion – Health Improvements for Ohio’s Women and Children

The Affordable Care Act (ACA) seeks to improve health in the United States by expanding insurance coverage, thereby improving access to health care that is high value and effective. Specific to women of reproductive age, the ACA expands coverage through health insurance exchanges and through optional state Medicaid expansions of enrollment eligibility to adults age 19-64 years (regardless of parental status) up to 138% of the Federal Poverty Level (FPL). The eligibility level for pregnant women varies by state with many states having expanded eligibility above 138% FPL for this population.

In 2014, the State of Ohio implemented enrollment of childless adults ≤138% FPL and parents between 91% and 138% FPL in Medicaid, along with enrollment of pregnant women up to 200% FPL through the ACA. These implementations incorporate a Medicaid Managed Care strategy that require the assignment of a primary care provider for all new enrollees and health homes for individuals with severe and persistent mental illness and other chronic health conditions.

The principal purpose of “Examining the Impact of Ohio’s Medicaid Expansion: Health Improvement for Ohio’s Women and Children” study is to examine the impact of Medicaid expansion on women of reproductive age and their infants by linking Medicaid administrative data to Ohio’s birth records. Findings from these linked data will be compared to population-based data from the Behavioral Risk Factor Surveillance System (BRFSS) and the Ohio Medicaid Assessment Survey (OMAS). A coalition of researchers representing policy, clinical practice, health services research, biostatistics, and epidemiology expertise from Medicaid and academia will examine health services utilization and outcomes among low-income women of reproductive age before and after ACA Medicaid expansion.  Ultimately, the work will culminate in the application of rigorous research methodologies and will explore potential associations between Medicaid expansion and changes in health services utilization, health status, and pregnancy outcomes.

The specific aims of this work, to be completed in 2018, are:

  • Aim 1: To iteratively develop and operationalize a research agenda in collaboration with ODM, ODH, GRC, and Emory University to evaluate the impact of Medicaid expansion on the health of Medicaid-eligible women of reproductive age and their pregnancies and birthed infants.
  • Aim 2: To perform the requisite validity checks and steps for linkage of Ohio birth certificate records and Medicaid administrative data (eligibility, enrollment, and claims), and to draw from other available survey data sources (including US Census, BRFSS, and OMAS) for consecutive years beginning with live births in 2008. 
  • Aim 3: To employ biostatistical methods to answer collaboratively-specified research questions and contextualize findings; prepare written manuscripts and oral presentations detailing findings;  and disseminate reports and presentations to key stakeholders within the state and nationally.  

This project is a partnership between the Ohio Department of Medicaid (ODM), the Ohio Department of Health (ODH), Emory University, and GRC.