Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #119456

Kay Johnson, MPH, EdM, Johnson Consulting Group, 175 Red Pine Road, Hinesburg, VT 05461, 802-482-3005, KJ813@aol.com and Molly McNulty, JD, McNulty Consulting, 57 Willard Avenue, Rochester, NY 14620.

Overview: The Medicaid expansions for pregnancy women had the goal of reducing financial barriers to early and continuous prenatal care for low-income women, with the expectation of improving outcomes and saving money on high-risk newborns. As enacted by Congress, the policy changes had four facets: a) expanded eligibility, b) streamlined eligibility, c) enhanced benefits /content of care, and d) increased reimbursement for obstetric services. Research Objective and Design: Preliminary findings and conclusions: Studies indicate that states which implemented a multifaceted strategy to Medicaid prenatal expansions were successful in improving the use of early and continuous prenatal care, and in some states the outcomes of pregnancy among this group of women with higher risk factors improved slightly. These same studies suggest that barriers to care continued to limit the potential impact of Medicaid prenatal expansions. Women who became eligible only after a confirmed pregnancy test experienced delays in enrollment and linkage to a provider. Despite Congressional mandates, states did not achieve automatic newborn enrollment with continuous coverage throughout the first year. Not all areas could assure access to providers who delivered appropriate and quality care. Provider payments were inadequate in many states, and the regulations requiring adequate reimbursement were repealed in 2000. The content of prenatal care generally did not conform to recommendations, and fewer women were eligible for interconception care. Welfare reform policies led to reductions in eligibility for women of childbearing age. Finally, with managed care, few states continued to emphasize approaches that had shown results.

Learning Objectives:

• - Review evidence on the impact of Medicaid on perinatal access and impact.
• - Discuss the factors underlying policy decisions about coverage of women and infants.
• - Describe a framework for revies and synthesis of this evidence.

Keywords: Pregnancy Outcomes, Medicaid

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation