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Impact of Medicare's contraceptive coverage gaps on contraceptive use among enrollees with disabilities
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. JAMA Network Open. 8(6).
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.
I recieved an F31 award from the Eunice Kennedy Shriver National Institute of Child Health & Human Development to support this project (F31HD116515).
State public coverage of pregnant undocumented immigrants and prenatal insurance uptake
State public coverage of pregnant undocumented immigrants and prenatal insurance uptake
Bellerose, M., Zheng, L., Desir, A., Fabi, R.E., Steenland, M.W. (2025). State public coverage of pregnant undocumented immigrants and prenatal insurance uptake. The Milbank Quarterly. 103(3): 0726.
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.
Systematic review on the effects of the ACA state Medicaid expansions on perinatal insurance, health care use, and health outcomes
Systematic review on the effects of the ACA state Medicaid expansions on perinatal insurance, health care use, and health outcomes
Bellerose, M., Collin, L., Daw, J. (2022). The ACA Medicaid expansion and perinatal insurance, health care use, and health outcomes: a systematic review. Health Affairs. 41(1).
In this systematic review of 24 studies published between January 2014 and April 2021, we found that the Affordable Care Act (ACA) state Medicaid expansions increased preconception and postpartum Medicaid coverage with corresponding declines in uninsurance, private insurance coverage, and insurance churn. We found limited evidence that Medicaid expansion increased perinatal health care use or improved infant birth outcomes overall, although some studies reported reduced racial and ethnic disparities in rates of prenatal and postpartum visit attendance, maternal mortality, low birthweight, and preterm births.
This paper was cited in the 2025 Economic Report of the President
Examining reasons for differences in self-reported postpartum visit use and postpartum visit use measured using Medicaid claims
Examining reasons for differences in self-reported postpartum visit use and postpartum visit use measured using Medicaid claims
Bellerose, M., Daw, J., Steenland, M.W. (2023). Differences in self-reported and billed postpartum visits among Medicaid-insured individuals. JAMA Network Open. 6(12).
In this cross-sectional study using South Carolina Medicaid claims data linked to Pregnancy Risk Assessment Monitoring System (PRAMS) survey responses, we found that estimates of postpartum visit use derived from Medicaid claims undercount postpartum visit receipt by systematically missing care received by unqualified immigrants with Emergency Medicaid for delivery and those who transition to private insurance during the postpartum period. Accounting for postpartum insurance transitions when conducting studies using Medicaid claims data may improve estimates of postpartum health care use and outcomes.
Testing whether self-reported survey data can be used to improve Medicare Advantage risk-adjustment accuracy
Testing whether self-reported survey data can be used to improve Medicare Advantage risk-adjustment accuracy
Bellerose, M., James, O., Shroff, J., Ryan, A., Meyers, D. (2025). Combining patient survey data with diagnosis codes improved Medicare Advantage risk-adjustment accuracy. Health Affairs. 44(1).
Under the current Medicare Advantage (MA) risk-adjustment system, plans are incentivized to "upcode," or report diagnosis codes on enrollees’ medical claims reflecting additional and more severe health conditions to increase enrollees’ risk scores and corresponding plan payments. In this study, we used national 2016-2019 medical and pharmaceutical claims linked to Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses from 151,432 MA enrollees to test four alternative methods of contructing risk scores that are less susceptible to upcoding. We found that relative to currently used models, models combining diagnosis codes with survey responses were more predictive of health care use, suggesting that survey responses could be used in tandem with diagnosis codes to improve the integrity and performance of MA risk adjustment.
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