# Assessing the role of Federally Qualified Health Centers in advancing quality and equity of care for pregnant and postpartum Medicaid enrollees

> **NIH NIH R01** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2024 · $721,358

## Abstract

PROJECT SUMMARY
Low-income pregnant and postpartum patients (PPP), especially persons of color, experience significant
inequities in quality of care and health outcomes across the perinatal period; this is driven, in part, by lack of
access to care, inadequate coordination and integration of primary care and maternity care, and failure to
address unmet social needs. Federally qualified health centers (FQHCs) could play a central role in addressing
these maternal health challenges, as the unique FQHC model includes providing access to culturally
competent care for underserved patients; integrating and coordinating primary and maternity care; and linking
patients to social services. While use of FQHCs versus other outpatient settings for primary care has been
associated with improved care quality, the impact of FQHC use for pregnancy care is unknown. Moreover, one
key factor affecting the ability of FQHCs to improve perinatal outcomes may include whether the FQHC directly
provides maternity services, with our preliminary data finding that 1 in 3 US FQHCs do not directly provide
prenatal care. Yet, there is no known literature on how offering maternity services at FQHCs may impact
pregnancy outcomes, despite important policy opportunities to expand services at FQHCs. Our long-term goal
is to identify effective health system reform strategies that improve outcomes and equity for low-income PPP.
As an immediate objective, this R01 will use a quasi-experimental, mixed methods approach to study if and
how FQHCs may improve access, quality, and equity of care for PPP, using national data on the universe of
Medicaid-covered births. The specific aims are to (1) Characterize Medicaid-enrolled PPP who receive care at
FQHCs vs non-FQHC practices (1-A) and compare quality of care-sensitive measures for these groups across
the prenatal (e.g., timely prenatal care), delivery (e.g., SMM, preterm birth), and postpartum (e.g., postpartum
linkage to primary care) periods, using entropy balancing to balance on observables (1-B); (2) Among PPP
who receive care at FQHCs, evaluate how expanding FQHC services to include maternity care impacts quality
of care-sensitive measures using a difference-in-differences study to compare measures for Medicaid-enrolled
PPP at FQHCs that implement maternity care vs FQHCs with continuous maternity care vs FQHCs with
continuous referral-only maternity care; and (3) Assess the role of FQHCs in integrating, coordinating, and
providing access to care for PPP through semi-structured interviews with health systems and FQHC
leadership, including successes and challenges of FQHCs in integrating and coordinating primary care,
maternity care, and social services for PPP, implications for quality and equity, and key policy opportunities
and challenges in expanding maternity care at FQHCs. All Aims will examine differential impacts by
racial/ethnic identity. Collectively, these aims will fill critical evidence gaps to help policymakers, Medicaid
...

## Key facts

- **NIH application ID:** 10939610
- **Project number:** 1R01MD019661-01
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Megan B. Cole
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $721,358
- **Award type:** 1
- **Project period:** 2024-08-14 → 2029-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10939610

## Citation

> US National Institutes of Health, RePORTER application 10939610, Assessing the role of Federally Qualified Health Centers in advancing quality and equity of care for pregnant and postpartum Medicaid enrollees (1R01MD019661-01). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10939610. Licensed CC0.

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