Affordable Care Act: Improving Health Service Utilization in Childbearing Women

Background: The Patient Protection Affordable Care Act provides opportunity for many low- income women to continue Medicaid and receive preventive/primary care before the next pregnancy.  We examined health service utilization in a population of pregnant women who had pre-existing Medicaid insurance and those with pregnancy-related Medicaid to identify targets for care improvement. We included Medicaid enhanced prenatal/postnatal care (EPC) utilization that is available to all Michigan Medicaid-insured women.

Methods: A cohort analysis of Medicaid-insured mother-infant pairs in Kent County, Michigan (singleton births, 2009, N=4,484) was conducted using linked vital records and claims data from the Michigan Department of Community Health Warehouse (*p=<0.01).

Results: Half of all pregnant women had pre-pregnancy Medicaid.  Compared to women without prior Medicaid, 24% of women with pre-existing Medicaid (vs. 25%) had inadequate/intermediate prenatal care; 65% (vs.67%) initiated first trimester care; 41% (vs.25%*) enrolled in EPC; and 21% (vs.5%*) had 3 or more prenatal emergency department (ED) visits.  While 56% (vs.43%*) completed a postpartum visit, 15% (vs.7 %*) used the ED during 8 weeks post-birth.  In the postpartum year, of those who had Medicaid before/after birth, 22% (vs.8 %*) had 3 or more ED visits.

Conclusions: Women with prior Medicaid were more likely to engage in EPC and postpartum visits, but there was still low participation; one in five women had frequent prenatal or postnatal ED use.  EPC programs, in 66% of states, could be optimized with targeted interventions to help newly-insured women use health resources. Community improvement strategies and early implementation findings will be discussed.