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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Drinking During Pregnancy.

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Strategy. Medicaid Expansion

Approach. Support the expansion of Medicaid to increase the number of women of reproductive age who have access to substance use prevention, screening, and treatment

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Overview. Medicaid expansion has been associated with a self-reported decrease in heavy and binge drinking among women of reproductive age.[1] Expansion states have seen an increase in health coverage, a decrease in avoiding healthcare due to costs, better self-reported health, and a decrease in excess alcohol consumption.[2] Medicaid benefits that provide easier access to preconception and interconception healthcare, including behavioral counseling, appear to increase the likelihood that recipients will reduce their alcohol consumption prior to becoming pregnant.[1,2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of women of reproductive age who become newly eligible for Medicaid as a result of expansion efforts. (Measures potential increase in access to prevention and treatment services) Number of substance use prevention, screening, and treatment services covered under expanded Medicaid benefits. (Assesses scope of services available to support women's health)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of women enrolled in Medicaid who are screened for substance use using evidence-based tools and practices. (Evaluates quality of early detection efforts) Percent of substance use treatment services offered to pregnant women enrolled in Medicaid that meet standards for comprehensive, gender-responsive care. (Assesses appropriateness of care provided)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of women who receive substance use prevention education through Medicaid and report increased knowledge of alcohol and drug-related health risks. (Shows educational impact of prevention efforts) Number of partnerships led by Title V established between Medicaid and community-based organizations to improve substance use service access and coordination. (Shows cross-sector collaboration efforts) Number of alcohol and drug-exposed pregnancies prevented among women with Medicaid coverage through expanded prevention and early intervention services. (Estimates averted adverse health outcomes) Number of pregnant women enrolled in Medicaid who achieve and maintain recovery from alcohol and substance use disorders. (Measures treatment impact on focus population)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of women who receive substance use prevention education through Medicaid and report increased knowledge of alcohol and drug-related health risks. (Shows educational impact of prevention efforts) Percent of partnerships led by Title V established between Medicaid and community-based organizations to improve substance use service access and coordination. (Shows cross-sector collaboration efforts) Percent of alcohol and drug-exposed pregnancies prevented among women with Medicaid coverage through expanded prevention and early intervention services. (Estimates averted adverse health outcomes) Percent of pregnant women enrolled in Medicaid who achieve and maintain recovery from alcohol and substance use disorders. (Measures treatment impact on focus population)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Myerson, R., Crawford, S., & Wherry, L. R. (2020). Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception. Health affairs (Project Hope), 39(11), 1883–1890.

[2] Margerison, C. E., MacCallum, C. L., Chen, J., Zamani-Hank, Y., & Kaestner, R. (2020). Impacts of Medicaid Expansion on Health Among Women of Reproductive Age. American journal of preventive medicine, 58(1), 1–11.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.