Perinatal Opioid Use Disorder Treatment Benefit Design and Maternal-Infant Outcomes in Medicaid Managed Care

About This Grant

PROJECT SUMMARY The United States faces a maternal health crisis driven by an ongoing opioid epidemic. As a result, mental health and substance use problems are the leading drivers of pregnancy-associated deaths in the United States. While opioid use disorder (OUD) treatment during pregnancy has been shown to reduce risk of death, improve health outcomes for mother and child, and reduce foster care entries, few pregnant women with OUD receive it. As the largest funder of pregnancy-related OUD services, Medicaid serves as an important policy lever to improve pregnancy-associated overdose mortality by improving coverage of OUD treatment — particularly within Medicaid managed care organization (MCO) as the majority of pregnant and postpartum Medicaid beneficiaries are enrolled in a MCO plan. Prior research on the general Medicaid population have demonstrated considerable discretion in MCO plan coverage and utilization management strategies offered for OUD treatment; however, no research has focused on MCO benefit variation in OUD treatment for pregnant and postpartum women. Examining variation in benefit design for this population in particular is important as they not only experience differences in coverage and utilization management strategies from the traditional adult population, but also require treatment that is safe and recommended for use during pregnancy and breastfeeding. To address this, the proposed study leverages a unique and highly integrated dataset in a state with automatic, random assignment into MCO plans so that we can link MCO benefit comprehensiveness to mother-infant dyads to examine the causal effect of such benefit design on perinatal OUD treatment utilization and OUD-related maternal health and child protective services outcomes. Aim 1 will examine how MCO plan perinatal OUD benefit design effects perinatal OUD treatment utilization— both psychosocial services and medication treatment for OUD. Aim 2 will examine how MCO plan perinatal OUD benefit design effects OUD- related maternal health outcomes (e.g. pregnancy-associated overdose mortality, opioid-related emergency department visits, and opioid-related hospitalizations) and child protective services outcomes (e.g. number of child welfare investigations, foster care entries and outcomes, time for reunification). As the first study to assess whether MCO plan benefit design impacts perinatal OUD treatment utilization and related maternal and child outcomes, findings from the proposed study will provide guidance to health policymakers on mandated benefit design coverage and utilization management strategies. As an NIH F31 predoctoral trainee, I will obtain skills using large-scale administrative claims and encounter data, using advanced statistical econometric methods, deepening my understanding of the intersection of substance use and maternal and child health, and disseminating research findings in peer-reviewed publications and scientific conference presentations.