No abstract

Objective To examine the effects of intimate partner violence (IPV) at varied time points in the perinatal period on inadequate and excessive gestational weight gain. Design Retrospective cohort using population-based secondary data. Setting Pregnancy Risk Assessment Monitoring System and birth certificate data, including New York City and 35 states. Participants Data were obtained for 251,342 U.S. mothers who gave birth from 2004–2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2–9 months after birth. Methods The exposure was perinatal IPV, defined as experiencing physical abuse by a current or ex-partner in the year before or during pregnancy. Adequacy of gestational weight gain (GWG) was categorized using 2009 Institute of Medicine guidelines. Weighted descriptive statistics and multivariate logistic regression models were used. Results Approximately 6% of participants reported perinatal IPV, 2.7% of participants reported IPV in the year before pregnancy, 1.1% reported IPV during pregnancy only, and the remaining 2.5% reported IPV before and during pregnancy. Inadequate GWG was more prevalent among participants who experienced IPV during pregnancy and those who experienced IPV before and during pregnancy (23.3% and 23.5%, respectively) than in participants who reported no IPV (20.2%; P < 0.001). Participants who experienced IPV before pregnancy only were significantly more likely to have excessive GWG (P < 0.001). Results were attenuated in the multivariate modeling; only participants who experienced IPV before pregnancy had weakly significant odds of excessive GWG (aOR 1.14, 95% CI 1.02–1.26). Conclusions The association between perinatal IPV with inadequate GWG was explained by confounding variables; however, women who reported perinatal IPV had higher rates of GWG outside of the optimal range. Future studies are needed to determine how relevant confounding variables may affect a woman’s gestational weight gain.

Background Children with medical complexity are a group of children with multiple chronic conditions and functional limitations that represent the highest health care utilization and often require a substantial number of home and community-based services (HCBS). In many states, HCBS are offered to target populations through 1915(c) Medicaid waivers. To date, no standard methods or approaches have been established to evaluate or compare 1915(c) waivers across states in the United States for children. Objective The purpose of this analysis was to develop a systematic and reproducible approach to evaluate 1915(c) Medicaid waivers for overall coverage of children with medical complexity. Methods Data elements were extracted from Medicaid 1915(c) approved waiver applications for all included waivers targeting any pediatric age range through October 31, 2018. Normalization criteria were established, and an aggregate overall coverage score was calculated for each waiver. Results Data extraction occurred in two phases: (1) waivers that were considered nonexpired through December 31, 2017, and (2) the final sample that included nonexpired waivers through October 31, 2018. A total of 142 waivers across 45 states in the United States were included in this analysis. We found that the existing adult HCBS taxonomy may not always be applicable for child and family-based service provision. Although there was uniformity in the Medicaid applications, there was high heterogeneity in how waiver eligibility, transition plans, and wait lists were defined. Study analysis was completed in January 2019, and after analyzing each individual waiver, results were aggregated at the level of the state and for each diagnostic subgroup. The published results are forthcoming. Conclusions To our knowledge, this is the first study to systematically evaluate 1915(c) Medicaid waivers targeting children with medical complexity that can be replicated without the threat of missing data. International Registered Report Identifier (IRRID) RR1-10.2196/13062

No abstract

Problem Many states cover mental health home and community‐based services (HCBS) for youth through 1915(c) Medicaid HCBS waivers that allow states to waive certain Medicaid eligibility criteria and define high‐risk populations based on age, medical condition(s), and disability status. We sought to evaluate how States are covering children and adolescents with mental health needs through 1915(c) waivers compared to other youth waiver populations. Methods Data elements were extracted from Medicaid 1915(c) approved waivers applications for all included waivers targeting any pediatric age range through October 31, 2018. Normalization criteria were developed and an aggregate overall coverage score and level of funding per person per waiver were calculated for each waiver. Findings One hundred and forty‐two waivers across 45 states were included in this analysis. Even though there was uniformity in the Medicaid applications, there was great heterogeneity in how waiver eligibility, transition plans, services covered, and wait lists were defined across group classifications. Those with mental health needs (termed serious emotional disturbance) represented 5% of waivers with the least annual funding per person per waiver. Conclusions We recommend greater links between public policy, infrastructure, health care providers, and a family‐centered approach to extend coverage and scope of services for children and adolescents with mental health needs.