Effects of a Medicaid home visiting perinatal program on maternal and child health: Who benefits the most?

Background There is renewed interest in broader dissemination of home visiting programs through funding under the Affordable Care Act. The Maternal and Infant Health Program (MIHP) provides home visiting and enhanced prenatal services for Medicaid eligible women and infants in Michigan. The objective is to evaluate the effectiveness of MIHP in improving maternal and infant assessing whether specific subgroups experience increased benefits

Methods The study population is all Medicaid eligible women who gave birth in 2009 and 2010, and their infants. We used statewide maternal and infant linked data spanning from the preconceptional period until the end of the first year after birth, including Medicaid claims, vital records, and program participation. This was a quasi-experimental evaluation of the MIHP effectiveness, specifically using propensity score matching.

Results Overall, MIHP participants had higher odds of receiving any prenatal care (OR=2.9), appropriate prenatal care (OR=1.06), appropriate postnatal checkups (OR=1.5) compared to matched equivalent non-participants. Their infants had lower odds of low birth weight (OR=0.9), very low birth weight (OR=0.7), and higher odds of receiving well-child visits (OR=1.7) and the appropriate number of well-child visits (OR=1.5). All results were significant (p<0.05). Women who enrolled in MIHP during the 1st trimester, teenage mothers, and first-time mothers experienced stronger MIHP effects.

Conclusions There was a pattern of significant favorable MIHP effects across a range of maternal and infant outcomes beginning during pregnancy, continued at birth, and sustained through the first year after birth. Early MIHP enrollees, teenage, and first-time mothers seemed to benefit more from MIHP.