# The Effects of Medicaid Policy Interventions on Racial Equity in Severe Maternal Morbidity

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $763,485

## Abstract

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.

## Key facts

- **NIH application ID:** 10888355
- **Project number:** 5R01NR020670-03
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Marian Patricia Jarlenski
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $763,485
- **Award type:** 5
- **Project period:** 2022-09-23 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10888355

## Citation

> US National Institutes of Health, RePORTER application 10888355, The Effects of Medicaid Policy Interventions on Racial Equity in Severe Maternal Morbidity (5R01NR020670-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10888355. Licensed CC0.

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