Dissertation Defense: Haley Director

Understanding the impact of policy on the prenatal genetics care delivery landscape Dissertation Committee Brittany Brown-Podgorski, PhD, MPH, Department of Health Policy and Management, School of Public Health (Committee Chair) Marian Jarlenski, PhD, MPH, Department of Health Policy and Management, School of Public Health Tamar Krishnamurti, PhD, School of Medicine Tina Batra Hershey, JD, MPH, Department of Health Policy and Management, School of Public Health Victoria Bacon, MS, MPH, LCGC, UPMC Magee Women's Hospital, UPMC Presbyterian Hospital - Heart and Vascular Institute Abstract Prenatal genetic testing evaluates the presence of fetal genetic anomalies and is an essential part of evidence-based prenatal care. Prenatal genetic counselors (GCs) often facilitate testing and care delivery, allowing pregnant people to make decisions about their current and future pregnancies. Though prenatal genetic testing is recommended during prenatal care, it is costly and often inaccessible to low-resourced and uninsured pregnant people. Medicaid coverage improves access to prenatal genetic services for low-income pregnant people, which may affect infant health outcomes. However, Medicaid coverage often varies across jurisdictions, and access to genetic services may be complicated by reproductive health policy changes following Dobbs v Jackson Women’s Health Organization (2022). This dissertation utilizes a multiple methods approach to better understand the policy landscape for prenatal genetic services and how it influences care delivery and infant health outcomes. Aim 1 uses a rigorous legal mapping technique to characterize Medicaid coverage for non-invasive prenatal testing (NIPT), amniocentesis, and chorionic villus sampling in 51 United States jurisdictions as of 2025. We redundantly coded state-level policies, noting policy sources, effective dates, eligibility criteria, covered conditions, and prior authorization requirements. Aim 2 uses national Pregnancy Ri