Medicaid managed care versus fee-for-service: Access and geographic barriers to prenatal care remain

Medicaid managed care (MMC) has become the dominant form of health care delivery, covering nearly 60% of Medicaid enrollees nationally. Yet, little conclusive evidence exists that indicates managed care either increases or decreases the number or use of preventive health services relative to Medicaid fee-for-service (FFS). This study compared prenatal care access among women in a five county MMC program home to the Beaumont-Port Arthur Metropolitan Statistical Area (MSA) and a similar Medicaid FFS area home to the Killen-Temple-Ft. Hood MSA. Using Texas Medicaid births records between 2000 and 2004, we assessed the adequacy of prenatal care as measured by the Kessner Index, timing of first prenatal care visit, number of prenatal care visits, and low birth weight rates. MMC mothers were more likely to receive adequate prenatal care (69.6% versus 50.9%, p<0.001) and to have received prenatal care from a private physician (75.87% versus 54.6%, p<0.001). All results remain significant after adjusting for mother's smoking, drinking or age <19 years as well as the setting of prenatal care. Despite having better access to care, MMC mothers were more likely to have low birth weight babies (<2500 grams) than those enrolled in FFS (8.3% versus 7.7%, p<0.005). Using geographic information systems (GIS), we also analyzed the spatial aspects of prenatal care access. Access barriers remain and deficiencies in prenatal care utilization are concentrated in specific areas and subpopulations. The findings indicate the importance in assessing potential policy and program options for reducing disparities in prenatal care access.