The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68218

M. Beth Benedict, DrPH, JD, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, 7500 Security Blvd., Mail Stop: C3-19-07, Baltimore, MD 21244-1850, 410-786-7724, bbenedict@cms.hhs.gov and Norma I. Gavin, PhD, Health, Social and Economics Research, RTI International, P.O. Box 12194, Research Triangle Park, NC 27709.

An important purpose of this CMS sponsored, study of 217,897 low-income, poverty and disabled enrolled, pregnant women covered by Medicaid in four racially diverse states. Because a disproportionately large percentage of disabled, pregnant women was Black non-Hispanic and a disproportionately small percentage was Hispanic, we conducted an in-depth assessment of the potential impacts of differences in care, costs, and outcomes. Using multi-variate analyses, unadjusted and adjusted odds ratios with confidence levels and significant tests at the .05 level, the study aimed to determine if factors such as race/ethnicity, Medicaid disability eligibility, behavior, education, pre-existing health risk, pregnancy-related complications, Medicaid enrollment duration explained differences in outcomes between the disabled and non-disabled, and within the disabled group. Compared to nondisabled, pregnant women the disabled were more likely to be enrolled in Medicaid before pregnancy, to seek early prenatal care and to have prescription vitamins; but they were less likely to have an adequate number of visits. The disabled were more likely to develop pregnancy-related complications with higher use of the emergency room and hospitalizations, and to experience more adverse maternal and newborn outcomes. Overall, racial differences tended to not account for inadequate prenatal care or for the higher adverse outcomes, except for Black disabled women who smoked or used alcohol or had drug dependence. The Hispanic disabled received less care resulting in lower total costs than other racial groups. The Black disabled, pregnant women were on average the most costly and had the highest rate of adverse maternal and newborn outcomes.

Learning Objectives:

At the conclusion of this presentation, the participant will be able to:
• Describe the differences in maternal and newborn outcomes that otherwise healthy, low-income or poverty enrolled women tend to experience as compared with the disabled enrolled women;
• Discuss the impacts of the race/ethnicity factor on the higher number of adverse outcomes among the disabled when compared with the non-disabled;
• Discuss the impacts of behavioral risk factors, pre-exisitng health conditions, Medicaid enrollment duration and pregnancy complications on the higher adverse maternal and newborns outcomes among the disabled enrolled women, and in particular, among the Black disabled enrolled women.

Keywords: Medicaid, Pregnancy Outcomes

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: not applicable
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.