Health Equity · 2 authors, 1 centre
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This policy analysis examines Massachusetts Medicaid ACOs through document review and interviews with ACO administrators, finding that birthing people were not explicitly addressed in early ACO goals and that organizational structures may hinder maternity care integration, though the 2023 waiver extension now prioritizes maternal health equity.
The analysis drew on public documents and interviews conducted in late 2021 and early 2022 with four ACO administrators who had worked with seven unique Medicaid ACOs. The authors found that birthing people were not an explicitly addressed population in the initial waiver goals, and that ACO administrators reported simply not focusing on this population in major initiatives during early implementation. The 2023 waiver extension now explicitly includes advancing health equity with a focus on maternal health as one of five goals, with plans for equity metric payments and stratified quality reporting. Implications suggest that explicit commitments to equity, improved data collection, and evidence-based policies such as doula coverage and postpartum Medicaid extension may be needed to meaningfully improve outcomes.
