Presenter:
Rebecca Stern
The cost of an abortion remains one of the greatest barriers to equitable reproductive healthcare access in the U.S.- particularly for low-income individuals who might carry an unwanted pregnancy to term simply because they cannot afford alternative options. This has wide-reaching consequences for the health and prosperity of families across the country. To address this, in 2018, Illinois enacted HB40, a new law to expand abortion coverage using state Medicaid funds. As a direct result, the number of Medicaid-funded abortions increased significantly, indicating improved access and prior unmet need. This project aims to quantify the human impact of this shift by estimating what socioeconomic disadvantages were prevented through increased access to reproductive healthcare in 2023. We supplemented our initial analysis of Medicaid claims data with sources from the CDC, Illinois state records, and peer-reviewed data on the economic, educational, and social effects of abortion access to calculate the number of families in 2023 who avoided higher risks of excess poverty, dependence on government assistance, debt, and domestic violence, among other variables. Additionally, we estimated the direct fiscal benefits of HB40 on both Medicaid beneficiaries and the state's Medicaid budget. More broadly, analyses like these are critical to illustrate the expansive impacts of equitable abortion access for Medicaid beneficiaries. We provide a broad context that aims to be digestible to those outside of the healthcare community, including the general public and policymakers. Food is Medicine: Assessing the Impacts of Food Insecurity on Perinatal Health in NC and Relevant Policy Opportunities
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Presenter: Rebecca Stern
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About Paper:
North Carolina's (NC) Healthy Opportunities Pilots ("Pilots") program aims to improve health outcomes by linking the health and social sectors to address nonmedical drivers of health, such as food insecurity, in qualifying Medicaid enrollees in certain regions. While the program is currently paused due to state budget negotiations, NC remains in a perinatal health and food insecurity crisis, which may intensify with recent federal changes to SNAP and Medicaid in the reconciliation bill. Food insecurity is associated with adverse perinatal outcomes, creating an opportunity to improve perinatal outcomes through "food is medicine" (FIM) programs and access to affordable, high-quality, nutrient-dense foods. We studied the associations between food insecurity and perinatal health in NC through a landscape analysis of county-level data on perinatal health and food insecurity outcomes. We also conducted a literature review of Medicaid policy levers to improve these outcomes. We identified that the Pilots are in counties with higher food insecurity, child food insecurity, and adverse perinatal outcomes compared to the rest of NC, making the services critical to helping improve perinatal outcomes. Improved access to nutrition supports, through NC Medicaid services and/or linkages to community and government nutrition supports, can improve perinatal health. Given the pause on the Pilots, our policy recommendations are (1) for NC Medicaid and the NC General Assembly to restart the Pilots for the pregnant population in current regions and expand services to all pregnant Medicaid beneficiaries, (2) for Medicaid health plans to provide medically tailored home-delivered meals, pantry stocking, or home visiting programs (to improve linkage to nutrition supports) for high-risk pregnant individuals outside of the Pilots using managed care authorities, and (3) for providers to improve rates of food insecurity screening of pregnant and postpartum people, including at well-child visits.
Source:
Duke University / 2025
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Presenter: Rebecca Stern