Current Projects

Impact of Medicare's contraceptive coverage gaps on contraceptive use among enrollees with disabilities

Bellerose, M., Ellison, J., Steenland, M.W., Meyers, D.J., Mitra, M., Shireman, T.I. (2025). Coverage gaps and contraceptive use among Medicare enrollees with disabilities.

In this national study of 1.6 million reproductive-aged women with disabilities, we found that women enrolled in Medicare, who are subject to out-of-pocket costs for contraceptives, had lower contraceptive use compared to women enrolled in Medicaid or dual enrolled, who are not subject to those costs. Using a staggered-entry difference-in-differences design, we found that gaining coverage of contraceptives through a transition from Medicare to dual Medicare-Medicaid enrollment led to a 35% increase in contraceptive use within 12 months.

This project was supported by an F31 award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (F31HD116515).

State public coverage of pregnant undocumented immigrants and prenatal insurance uptake

Bellerose, M., Zheng, L., Desir, A., Fabi, R.E., Steenland, M.W. (2025). Association between state public coverage of pregnant undocumented immigrants and prenatal insurance coverage.

In January 2025, 24 states and DC offered public insurance to pregnant undocumented immigrants who were income-eligible for Medicaid. Using 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) responses linked to maternal nativity from birth certificate records from 19 states and the District of Columbia, we found that residing in a state with public coverage of pregnant undocumented immigrants was associated with increased prenatal Medicaid coverage among immigrants and was not associated with corresponding reductions in private or other insurance coverage. Offering state public insurance to pregnant undocumented immigrants could increase immigrant’s access to insurance coverage and recommended care during pregnancy.

Disabled women's experiences navigating health insurance and healthcare costs during pregnancy and postpartum

Between February and April 2025, I interviewed 31 women with disabilities who gave birth in the United States within the past five years to understand how health insurance and healthcare costs affected their pregnancy and postpartum care use and wellbeing. Their experiences will provide information on how health insurance plans can better support people with disabilities during pregnancy, delivery, and postpartum.

Prenatal care fragmentation and clinician access by public health insurance type and disability status

In this national study using 2016-2022 Traditional Medicare (TM), Medicare Advantage (MA), and Medicaid claims data, we will evaluate differences in prenatal care use and clinician characteritics by public health insurance coverage (TM, MA, Medicaid) and disability status (any disability, SSDI/SSI disability, no disability). We will examine pregnancy-level outcomes, including timing of prenatal care initiation, number of prenatal care visits, number of clinicians seen for prenatal care, clinician specialty, differential distance travelled to primary clinician vs nearest available clinician, and prenatal care fragmentation. We will also evaluate access to prenatal care clinicians by examining two clinician-level outcomes: share of practicing clinicians who saw a patient with each insurance type, and share of practicing clinicians who saw a patient with each of three disability types: blind or reduced vision, Deaf or hard of hearing, and mobility impairment.

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