Study finds persistent disparities in access

According to an analysis published in Open JAMA Network October 28.

The study, conducted by researchers from the Icahn School of Medicine at Mount Sinai and the University at Albany, SUNY, covered the period between 2011 and 2019, a time when access to prenatal care (defined by study as health care provided to pregnant women in the first trimester) was increased in states that expanded Medicaid under the Affordable Care Act.

While access to timely prenatal care has increased overall after the expansion of Medicaid, disparities between immigrant and US-born pregnant women have increased among those of Hispanic descent. In states that expanded Medicaid, 76.3% of immigrant Hispanic pregnant women received timely prenatal care after the expansion, compared to about 81.1% of American-born Hispanic pregnant women.

According to the Centers for Disease Control and Prevention, approximately one in four births in the United States is to an immigrant or non-US citizen. Some immigrants are excluded from safety net programs, including Medicaid, which provides health care to low-income US citizens.

“Our study shows that exclusions of immigrants from Medicaid eligibility can exacerbate disparities,” said co-corresponding author Teresa Janevic, PhD, MPH, associate professor of obstetrics, gynecology, and life sciences. reproduction, population health science and policy, and health systems design and global health. at Icahn Mount Sinai. “Timely and appropriate access to antenatal care is important because it benefits mothers and infants beyond pregnancy and childbirth. We know that insurance coverage before pregnancy leads to an earlier start of prenatal care; therefore, Medicaid coverage before pregnancy is an important lever for improving timely prenatal care.

The cross-sectional analysis used data from the National Center for Health Statistics and examined the prenatal care of more than 6 million pregnant people before and after Medicaid expansion in 16 states, including 400,000 immigrant pregnant women. The researchers also took into account characteristics such as age, number of children, level of education, race and ethnicity.

Dr. Janevic said the findings could inform current policy discussions about maternal health equity, demonstrating that some Medicaid coverage restrictions based on immigration status contribute to disparities between the native-born and immigrants seeking prenatal care in the United States. The study also encourages health care workers and policymakers to address how citizen exclusions from health care and benefits contribute to the structural racism faced by immigrant communities, she said.

“Non-citizens face many barriers to obtaining health coverage during and outside of pregnancy,” said co-corresponding author Ashley M. Fox, PhD, MA, associate professor of public administration and politics at the University of Albany, SUNY. “The pathways available to immigrants to access care are often complex and vary by qualifying status, time spent in the country, and state or locality of residence. Recent policy changes that expanded Medicaid eligibility, both before and during the COVID-19 pandemic, have often inadvertently or inadvertently excluded immigrants.

About Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metropolitan area, with more than 43,000 employees working in eight hospitals, more than 400 outpatient practices, nearly 300 laboratories, a nursing school and a large school of medicine and higher education. Mount Sinai advances health for everyone, everywhere, by addressing the most complex health challenges of our time – discovering and applying new knowledge and scientific knowledge; developing safer and more effective treatments; train the next generation of medical leaders and innovators; and supporting local communities by providing high quality care to all who need it.

Through the integration of its hospitals, laboratories and schools, Mount Sinai offers comprehensive healthcare solutions from birth to geriatrics, leveraging innovative approaches such as artificial intelligence and IT while keeping patients’ medical and emotional needs at the center of all treatments. The health system includes approximately 7,300 primary and specialty care physicians; 13 joint venture day surgery centers in the five boroughs of New York, Westchester, Long Island and Florida; and over 30 affiliated community health centers. We are regularly ranked by US News and World Report‘s Best Hospitals, receiving a high “Honor Roll” status, and are highly ranked: #1 in Geriatrics and top 20 in Cardiology/Cardiac Surgery, Diabetes/Endocrinology, Gastroenterology/Gastrointestinal Surgery, Neurology/Neurosurgery, orthopaedics, pulmonology/lung Surgery, rehabilitation and urology. New York Eye and Ear Infirmary of Mount Sinai is ranked #12 in ophthalmology. US News and World ReportMount Sinai Kravis Children’s Hospital’s “Best Hospitals for Children” ranking is one of the best in the country in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that has distinguished itself by several indicators: it is consistently ranked in the top 20 by US News and World Report“Best Medical Schools”, aligned with a US News and World Report “Honor Roll” Hospital, and among the top 20 in the nation for funding from the National Institutes of Health and among the top 5 in the nation for many areas of basic and clinical research. Newsweek“World’s Best Smart Hospitals” ranks Mount Sinai Hospital #1 in New York and among the top five in the world, and Mount Sinai Morningside in the top 30 worldwide; Newsweek Mount Sinai Hospital also ranks Mount Sinai Hospital leading in 11 specialties as “World’s Best Specialty Hospitals” and “America’s Best Physical Rehabilitation Centers”.

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