An Examination of the Effects of a Medicaid Postpartum Depression Screening Requirement and Related Federal and State Policies on Perinatal Mental Health Diagnosis and Treatment among Medicaid-Insured Women in Michigan
Open Access DepositedPerinatal mental health conditions include depression, anxiety, and other mood disorders that occur during pregnancy through one year after delivery, with substantial underdiagnosis and unmet treatment needs. In 2018, Michigan added a requirement to screen for postpartum depression during well-child visits to its Medicaid provider manual. My dissertation explores the effects of this policy on diagnosis and treatment of postpartum mental health conditions among Medicaid-insured women in Michigan.In my first paper, I used Michigan Medicaid data from 2014-2022 to conduct an interrupted time series evaluating how diagnosis and treatment rates for postpartum mental health conditions changed after Michigan Medicaid added the screening requirement. In my second paper, I added an interaction term to the interrupted time series and conducted stratified analyses to assess whether the policy improved inequities in treatment. For my third paper, I conducted a scoping review of federal and Michigan-based policies to explore how Michigan is addressing perinatal mental health aside from the screening requirement. I found that introduction of the policy increased postpartum depression diagnosis rates by 15 percent among Michigan Medicaid-insured women. However, I found no meaningful effects on diagnosis of anxiety, diagnosis of substance use disorder, or any treatment outcomes. My analysis also showed a modest improvement in inequities in diagnosis and treatment rates during the study period, but I was unable to attribute any improvements in inequities to the Medicaid policy relative to changes in national clinical guidelines implemented around the same time. My scoping review identified other policies that may have also improved inequities in diagnosis and treatment, such as required referrals to Michigan’s home visiting program for pregnant and postpartum Medicaid beneficiaries. These findings have implications for understanding the extent to which state Medicaid policies like required postpartum depression screening can affect how perinatal mental health conditions are detected and treated among individuals with different backgrounds and experiences. Further research is needed to determine the magnitude of each policy’s impact.
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