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149789 Redesigning state Medicaid policy and programs to support improvement in pregnancy outcomesMonday, November 5, 2007: 8:35 AM
Background: Medicaid insures almost 40% of births in the U.S. and, with federal MCH block grant funding, provides additional resources for enhanced prenatal services (EPS) to improve pregnancy outcomes. Despite these investments, health disparities persist at birth. We report on Michigan's efforts to evaluate and redesign an EPS program and the development and feasibility testing of a two tiered risk screening and assessment tool.
Methods: We describe a state-wide evaluation of EPS program participation by maternal risks (N = 46,617). We also describe preliminary results using the new tool, which includes well established instruments for stress, health behaviors and mental health, in a convenience sample of Medicaid insured women (N = 816). Findings: Many women with modifiable risk factors were not receiving EPS services (e.g. statewide 72% of women who reported smoking had no program contact). The new tool revealed important nuances in maternal risks. For example, 32% of women reported smoking. Of them, 16% smoke a pack/day or more, 50% are highly addicted, and 54% have tried to quit. Also, while 54% of women screened positive using a brief depression screen (PHQ-2), a second tier assessment (Edinburgh Depression Scale), indicated that 34% of these women had symptoms consistent with probable major depression. Additional results will be presented. Policy Implications: The new tool reveals important information to tailor evidence-based strategies to level of risk and readiness to change. Changes in state Medicaid policy (e.g. reimbursement) were made to support implementation. Implications for program change will be discussed.
Learning Objectives: Keywords: Medicaid, Screening Instruments
Presenting author's disclosure statement:
Any relevant financial relationships? No I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.
See more of: The Role of Politics and Public Policy In Improving Pregnancy Outcomes
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