The burdens of racist policies have produced vastly worse pregnancy and birth outcomes for Black and Native populations relative to White populations in the United States. Because state Medicaid programs are the largest single payer for pregnancy care in the country, changes to Medicaid policies are an important way to implement structural interventions to promote racial equity.  

This project will investigate the implementation of and effects of 3 equity-focused policies in Pennsylvania's Medicaid program: a payment incentive available to Medicaid health plans that achieve excellent outcomes for Black pregnant persons and young children; bundled payment model for pregnancy care that rewards providers who reduce racial inequities; and implementation of Regional Accountable Health Councils to design equity-focused community interventions. The results will inform discussion around how state Medicaid programs can use structural interventions to promote racial equity and justice.