Stakeholder Feedback on Implementation of the Managed Care Expansion in Long-Term Services and Supports (Round 3, June 2020)

Mexican immigrants, the largest group of immigrants in the US, are rapidly aging, but current research often aggregates US Latinos, overlooking origin and nativity-specific social, structural, and migration-related factors that influence Alzheimer’s disease (AD) and Alzheimer’s disease and related dementias (ADRD) risk. Attention to specific immigrant populations is necessary to address heterogeneity in cognitive risk factors. To address this gap, this research project focuses on loneliness, a risk factor for AD/ADRD that may be heightened in the older Mexican immigrant population. Using data from a nationally representative panel survey, complemented by data from a Rutgers-based cohort that collects advanced biomarkers, the project uses causal inference to analyze the inter-relationship between loneliness, social relationships, inflammation, and cognition for Mexican immigrants in the US compared to non-migrants, advancing understandings of modifiable risk factors for AD/ADRD.

A major challenge for Robert Wood Johnson Barnabas Health (RWJBH) primary care practices is managing patients with co-occurring chronic and behavioral health conditions. Integrated behavioral health (IBH) is a solution for improving quality and clinical outcomes for patients with co-occurring behavioral and physical health conditions by embedding behavioral health providers into the primary care setting. This study is a mixed methods, comparative case study using learning health system science to establish the value of IBH at RWJBH, promoting system-wide adoption via three aims: 1) Identify the top critical metrics for establishing the value of IBH; 2) Align the critical metrics with existing datasets at RWJBH practices and build a pilot dashboard; and 3) Assess the preliminary value of IBH in the case study sites. This project is being led by investigators from Rutgers Center for State Health Policy and Rutgers University Behavioral Health Care and is supported by a grant from the Learning Health System Scientist Training and Research in New Jersey (LHS STAR NJ) Research Project Award Program through the U.S. Agency for Healthcare Research and Quality.

This study aims to: (1) assess the independent and synergistic effects of extreme heat and prescription opioids and other heat-sensitizing medications on heat-related adverse events in low-income pregnant women; (2) assess the independent and synergistic effects of air pollution, i.e., particulate matter (PM2.5), and medications associated with thromboembolic and bleeding events on these outcomes; and (3) assess the independent and synergistic effects of extreme heat/air pollution and potentially teratogenic medications on the incidence of congenital abnormalities. The results of this study will quantify the effects of extreme heat and air pollution exposure and their potential interactions with medication use in low-income pregnant women while also shedding light on potential mechanisms that confer increased risk to certain individuals. The evidence generated from our study will have a direct impact on shaping adaptation strategies and policies for extreme weather events to protect high-risk pregnant women from the effects of extreme heat and air pollution.

Improving maternal, infant and child health and wellbeing (MCH) is an urgent public health priority. Birthing people are experiencing increases in severe maternal morbidity (SMM) and other pregnancy-related health conditions, while infant mortality in the first year of life remains greater in the U.S. than any other higher- income country. There are substantial racial and ethnic inequities and disparities in MCH, which are strongly influenced by social determinants. Thus, successfully advancing MCH in the U.S. requires interventions that address underlying factors that affect health among disinvested communities, such as housing. Homelessness is a growing phenomenon in the U.S. More than 1.2 million people experience homelessness each year, and the number of people experiencing homelessness on a single night has been rising each year since 2016. Women and girls are one of the fastest growing demographic groups among people experiencing homelessness (PEH), and 4% of all birthing people experience homelessness in the year prior to delivery. Health outcomes and behaviors associated with homelessness, such as lacking access to a regular source of medical care, are known risk factors for pregnancy-related morbidity and adverse birth outcomes. Members of racial and ethnic minoritized groups, who are more likely to face health-limiting systemic disadvantages, are overrepresented among PEH, further exacerbating inequities in MCH. However, critical gaps in our understanding of how homelessness affects MCH, and how evidence-based housing services affect MCH, limit our ability to implement effective interventions. Our overall objective is to assess how and when the experience of homelessness affects maternal and infant health and racial and ethnic health inequities, and whether Permanent Supportive Housing (PSH) and Rapid Rehousing (RRH) interventions have a positive impact on these outcomes. 

Our multidisciplinary team will apply quasi-experimental methods to linked administrative data that include homeless and housing service information, Medicaid claims, all-payer hospital records, and birth records. In Aim 1, we estimate effects of homelessness on maternal health conditions, health behaviors and healthcare utilization during pregnancy. In Aim 2, we estimate effects of homelessness on postpartum maternal and infant health and healthcare utilization. Our longitudinal dataset allows us to explore the timing of exposure, account for preconception health and compare outcomes across different pregnancies for the same person. In Aim 3, we estimate effects of PSH and RRH in this population. We use a difference-in-differences framework to provide the first quantitative estimates of the impact of these interventions on maternal and infant health and racial and ethnic health inequities. Guided by our advisory board members’ lived experience and clinical training, findings will be used to develop intervention studies and inform policy to improve prenatal and postpartum care for birthing people and infants who have experienced homelessness.

This proposal aims to assess whether implementing continuous Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) was associated with improvements in children’s academic and developmental outcomes and its role in addressing inequities by race, ethnicity, and income. Medicaid and CHIP cover over 37 million children in the U.S., including the majority of children in poverty and children of color. However, many children still face gaps in coverage. In response to COVID-19, all states temporarily implemented continuous Medicaid under the March 2020 FFCRA, allowing children to stay consistently enrolled without gaps. Previously, approximately half of states offered 12 months of continuous eligibility for children. This variation provides an opportunity to examine whether newly implementing continuous eligibility led to better educational and developmental outcomes—particularly for children more likely to be Medicaid-enrolled. Using nationally representative data from the National Survey of Children’s Health (2017–2022), this research will use a difference-in-difference design to compare academic and developmental outcomes before and during the FFCRA among states that did and did not newly implement continuous eligibility, with analyses by children’s race, ethnicity, and poverty level. These findings could inform how national 12-month continuous eligibility for children, starting in 2024, could help advance equity in developmental and academic outcomes.