Association of Michigan Medicaid's Depression Screening Requirement With Changes in Racial and Ethnic Inequities in Diagnosis and Treatment for Perinatal Mental Health Conditions.

BACKGROUND

Perinatal mental health conditions are more prevalent, yet less commonly treated, among people of color compared with white women.

METHODS

We conducted an interrupted time series analysis using 2014-2022 Michigan Medicaid claims data to assess the impact of Michigan Medicaid's 2018 requirement to screen for postpartum depression during well-child visits on racial/ethnic differences in maternal mental health diagnosis and treatment outcomes.

RESULTS

The sample included 254,890 women and was composed of 137,769 white, 81,257 Black, and 16,358 Hispanic women. Compared with white women, the 2018 policy introduction led to a greater level change in rates of postpartum depression diagnosis for Hispanic women (adjusted odds ratio [aOR] 1.26; 95% confidence interval [CI] [1.03, 1.54]) and a greater level change in rates of medication for those with depression or anxiety among Black (aOR 1.13; 95% CI [1.04, 1.23]) and Hispanic women (aOR 1.23; 95% CI [1.06, 1.44])-reducing but not eliminating inequities in diagnosis and treatment of depression and anxiety. Black women saw a decline in diagnosis (aOR .91; 95% CI [.85, .98]) and treatment (aOR .91; 95% CI [.85, .98]) for substance use disorder compared with white women. After the policy introduction, Black and Hispanic women experienced larger trend increases in all outcomes, moderately reducing inequities. Sensitivity analyses changing the interruption date to 2017 showed stronger differences in trend changes for most outcomes.

CONCLUSIONS

Although inequities in diagnoses and treatment for those with postpartum depression or anxiety between 2014 and 2022 modestly improved, Michigan's 2018 Medicaid policy did not eliminate inequities in maternal mental health conditions. Policymakers at the federal and state levels should consider additional ways to improve treatment of perinatal mental health conditions among Black and Hispanic women.