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Health policy evaluation in Missouri: From the perspective of a native Marylander

Written by Isha Yardi, BS candidate in public health science at University of Maryland College Park, and the Colonel Carroll A. Ockert Scholar in the Institute for Public Health Summer Research Program

This summer in the Institute for Public Health Summer Research Program – Public & Global Health Track, I had the incredible opportunity to work with Timothy McBride, PhD, MS, and the Center for Health Economics and Policy to support the center’s current work on Medicaid expansion evaluation in Missouri. This past legislative session, a bill was introduced into the Missouri House of Representatives to institute work and community engagement requirements for individuals seeking Medicaid coverage in Missouri. My project focused on both characterizing who would be affected by these work requirements and evaluating whether this legislation adequately advances the objectives of the Medicaid program.

I’ve lived in Maryland my whole life, and my interest in health policy grew from my experience doing policy research and advocacy in both County and State-level offices. When I first started working with McBride and his team, I was shocked to find that Medicaid expansion was approved in Missouri just a year and a half ago, while Maryland had expanded Medicaid eligibility when national expansion became effective back in 2014. Working on policy research in a state other than Maryland this summer has really broadened my perspective on the unique challenges different states face in health policy development and implementation.

Policy is really the crux of building healthy communities, and this summer has taught me that policy involves so much more than just development and passage of legislation. Evaluation and forecasting is key in designing policies that maximize impact, and it is incredibly difficult to get just right.

McBride’s team and I used supplements from the Current Population Survey to characterize individuals who would be most vulnerable to the institution of work requirements for Medicaid coverage, and I was shocked to find how elaborate this process was. We would talk for hours to identify variables and discuss cuts in the data that would build an accurate representation of the people who would be affected by work requirements. The level of accuracy and precision policy evaluation tries to approach is so important because evaluation informs decision-making, which ultimately affects hundreds of thousands of people and their well-being.

I’m so grateful to have worked with Professor McBride and Center for Health Economics and Policy this summer. Learning about policy evaluation in the context of a state that is markedly different from Maryland has better equipped me to tackle a diverse set of policy challenges in the future. I’m excited to take this experience forward into a career as a physician-public servant, where I hope to use what I’ve learned about policy evaluation to develop innovative solutions to health challenges faced by my community.

The author spending time in Forest Park in St. Louis.