Utilization of health and community services among pregnant women enrolled in Medicaid
Background: Our nation will provide health coverage for a greater number of women in their reproductive years under health reform. Yet, there is little understanding of how pregnant and postpartum women, currently covered by Medicaid, use health care. Objective: The objective of this study is to describe the utilization of medical care, Medicaid care coordination (enhanced prenatal services, EPS), and postpartum care among pregnant women enrolled in Medicaid. Methods: A statewide descriptive analysis of mother-infant pairs, singleton live births in 2009, was conducted using linked vital record, Medicaid expenditures, and EPS data from the Michigan Department of Community Health Data Warehouse. Results: Among the 62,052 mother-infant pairs, about 24% of all Medicaid insured women in Michigan received less than adequate (Kotelchuck) prenatal care (PNC). Forty-six percent of women had emergency department claims during pregnancy. Only 27% of women were enrolled in EPS care coordination. Although prenatal care providers make most EPS referrals (only 16% of women engage in EPS before PNC), only 24% women were enrolled in EPS in the month they initiated PNC. After delivery, only 40% of all women had evidence of a postpartum visit. About 51% of women remained on Medicaid for the first year post birth. Of women who dropped off Medicaid after birth, only 11% enrolled in Medicaid Family Planning Waiver program. Conclusion: Care for Medicaid insured pregnant women is underutilized and fragmented. A better organized system of care is needed, including integration of care coordination, to improve population health for women and infants.
Public health or related research
Describe the utilization of medical care, Medicaid care coordination, and postpartum care among pregnant women enrolled in Medicaid
Keyword(s): Maternal Care, Health Care Utilization
Presenting author's disclosure statement:
Qualified on the content I am responsible for because: I have been involved with research and evaluation initiatives within the local community focused on health services research in maternal and child health particularly for the Medicaid population for nine years. Projects included evaluation of Michigan's Maternal Infant Health Program for the Michigan Department of Community Health and Resident Research. I currently manage a Demonstration of a System of Care for Medicaid Insured Pregnant Women Project funded by Agency for Healthcare Research and Quality, R18HS020208.
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.