In the mid 1980s, Medicaid expanded pregnancy-related health care coverage. Substantially expanded coverage requirements were implemented in 1991; by 1992, nearly half of all women in the U.S. were eligible for Medicaid coverage for pregnancy-related expenses. Over the past decade, Medicaid managed care (MMC) has grown to be the primary form of service delivery within Medicaid: 57% of Medicaid recipients were enrolled in MMC in 2001, up from 10% in 1991. Effects of the introduction of MMC on pregnancy outcomes are unclear. Managed care may enhance care coordination, improving access and quality, particularly for minorities, however, managed care potentially provides incentives for under-provision of services.

This project will examine differences in access to care for pregnant women enrolled in MMC and Medicaid fee-for-service, and examine differences in the impact of MMC on access among rural and minority persons. To assess differences, we will use an indicator of access to primary and prenatal care. This indicator, the Potentially Avoidable Maternity Complications, uses hospital discharge data to identify pregnancy-related complications that may often be prevented through routine prenatal and primary care.

Publications

• Impact of Medicaid Managed Care, Race/Ethnicity, and Rural/Urban Residence on Potentially Avoidable Maternity Complications: A Five-State Multi-Level Analysis
  Rural and Minority Health Research Center
  Date: 12/2004
  This study examines pregnancy-related complications using Potentially Avoidable Maternity Complications as an indicator of access.
• Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina
  Journal Article
  Rural and Minority Health Research Center
  Date: 2006
  Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Potentially avoidable maternity complications in rural hospitals, African Americans had higher risk for complications than did non-Hispanic whites.