Moving to mandatory Medicaid managed care in Ohio: Impacts on pregnant women and infants

Genevieve Kenney, Anna Stauber Sommers, Lisa Dubay

Research output: Contribution to journalArticle

Abstract

Background: Understanding the impacts of Medicaid managed care on pregnant women is critical because Medicaid covers more than a third of all births nationally, many under managed care arrangements. Objectives: We sought to examine the impacts of mandatory Health Maintenance Organization (HMO) enrollment on prenatal care use, smoking, and birth weight for Medicaid-covered pregnant women in Ohio. Research Design: Impact estimates are derived from a prepost design with a comparison group, using Ohio birth certificate data linked to Medicaid enrollment files. Between April 1993 and April 1995 is the baseline period and October 1997 to June 1998 is the postperiod. The treatment group consists of deliveries in 6 counties that implemented mandatory HMO enrollment in the mid 1990s; the comparison group consists of deliveries in 4 counties with voluntary HMO enrollment. Subjects: Medicaid-covered deliveries to 24,799 non-Hispanic white women with no college education living in Ohio. Measures: Seven outcomes are analyzed: first trimester care; last trimester or no care; adequate prenatal care; inadequate prenatal care; smoking during pregnancy; and birth weight. Results: Our findings indicate that mandatory HMO enrollment in Ohio's Medicaid program had positive effects on prenatal care and led to reductions in maternal smoking. No effects were found on birth weight. Conclusions: Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.

Original languageEnglish (US)
Pages (from-to)683-690
Number of pages8
JournalMedical Care
Volume43
Issue number7
DOIs
StatePublished - Jul 2005
Externally publishedYes

Fingerprint

Medicaid
Managed Care Programs
managed care
Pregnant Women
Prenatal Care
infant
Health Maintenance Organizations
smoking
Smoking
Birth Weight
organization
health
Mothers
Birth Certificates
Group
Third Pregnancy Trimester
First Pregnancy Trimester
research planning
certification
pregnancy

Keywords

  • Managed care
  • Medicaid
  • Pregnant women
  • Prenatal care
  • Smoking

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Moving to mandatory Medicaid managed care in Ohio : Impacts on pregnant women and infants. / Kenney, Genevieve; Sommers, Anna Stauber; Dubay, Lisa.

In: Medical Care, Vol. 43, No. 7, 07.2005, p. 683-690.

Research output: Contribution to journalArticle

Kenney, Genevieve ; Sommers, Anna Stauber ; Dubay, Lisa. / Moving to mandatory Medicaid managed care in Ohio : Impacts on pregnant women and infants. In: Medical Care. 2005 ; Vol. 43, No. 7. pp. 683-690.
@article{94561342c66d4c65a8eddb4dbf4fd878,
title = "Moving to mandatory Medicaid managed care in Ohio: Impacts on pregnant women and infants",
abstract = "Background: Understanding the impacts of Medicaid managed care on pregnant women is critical because Medicaid covers more than a third of all births nationally, many under managed care arrangements. Objectives: We sought to examine the impacts of mandatory Health Maintenance Organization (HMO) enrollment on prenatal care use, smoking, and birth weight for Medicaid-covered pregnant women in Ohio. Research Design: Impact estimates are derived from a prepost design with a comparison group, using Ohio birth certificate data linked to Medicaid enrollment files. Between April 1993 and April 1995 is the baseline period and October 1997 to June 1998 is the postperiod. The treatment group consists of deliveries in 6 counties that implemented mandatory HMO enrollment in the mid 1990s; the comparison group consists of deliveries in 4 counties with voluntary HMO enrollment. Subjects: Medicaid-covered deliveries to 24,799 non-Hispanic white women with no college education living in Ohio. Measures: Seven outcomes are analyzed: first trimester care; last trimester or no care; adequate prenatal care; inadequate prenatal care; smoking during pregnancy; and birth weight. Results: Our findings indicate that mandatory HMO enrollment in Ohio's Medicaid program had positive effects on prenatal care and led to reductions in maternal smoking. No effects were found on birth weight. Conclusions: Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.",
keywords = "Managed care, Medicaid, Pregnant women, Prenatal care, Smoking",
author = "Genevieve Kenney and Sommers, {Anna Stauber} and Lisa Dubay",
year = "2005",
month = "7",
doi = "10.1097/01.mlr.0000167180.03824.fb",
language = "English (US)",
volume = "43",
pages = "683--690",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Moving to mandatory Medicaid managed care in Ohio

T2 - Impacts on pregnant women and infants

AU - Kenney, Genevieve

AU - Sommers, Anna Stauber

AU - Dubay, Lisa

PY - 2005/7

Y1 - 2005/7

N2 - Background: Understanding the impacts of Medicaid managed care on pregnant women is critical because Medicaid covers more than a third of all births nationally, many under managed care arrangements. Objectives: We sought to examine the impacts of mandatory Health Maintenance Organization (HMO) enrollment on prenatal care use, smoking, and birth weight for Medicaid-covered pregnant women in Ohio. Research Design: Impact estimates are derived from a prepost design with a comparison group, using Ohio birth certificate data linked to Medicaid enrollment files. Between April 1993 and April 1995 is the baseline period and October 1997 to June 1998 is the postperiod. The treatment group consists of deliveries in 6 counties that implemented mandatory HMO enrollment in the mid 1990s; the comparison group consists of deliveries in 4 counties with voluntary HMO enrollment. Subjects: Medicaid-covered deliveries to 24,799 non-Hispanic white women with no college education living in Ohio. Measures: Seven outcomes are analyzed: first trimester care; last trimester or no care; adequate prenatal care; inadequate prenatal care; smoking during pregnancy; and birth weight. Results: Our findings indicate that mandatory HMO enrollment in Ohio's Medicaid program had positive effects on prenatal care and led to reductions in maternal smoking. No effects were found on birth weight. Conclusions: Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.

AB - Background: Understanding the impacts of Medicaid managed care on pregnant women is critical because Medicaid covers more than a third of all births nationally, many under managed care arrangements. Objectives: We sought to examine the impacts of mandatory Health Maintenance Organization (HMO) enrollment on prenatal care use, smoking, and birth weight for Medicaid-covered pregnant women in Ohio. Research Design: Impact estimates are derived from a prepost design with a comparison group, using Ohio birth certificate data linked to Medicaid enrollment files. Between April 1993 and April 1995 is the baseline period and October 1997 to June 1998 is the postperiod. The treatment group consists of deliveries in 6 counties that implemented mandatory HMO enrollment in the mid 1990s; the comparison group consists of deliveries in 4 counties with voluntary HMO enrollment. Subjects: Medicaid-covered deliveries to 24,799 non-Hispanic white women with no college education living in Ohio. Measures: Seven outcomes are analyzed: first trimester care; last trimester or no care; adequate prenatal care; inadequate prenatal care; smoking during pregnancy; and birth weight. Results: Our findings indicate that mandatory HMO enrollment in Ohio's Medicaid program had positive effects on prenatal care and led to reductions in maternal smoking. No effects were found on birth weight. Conclusions: Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.

KW - Managed care

KW - Medicaid

KW - Pregnant women

KW - Prenatal care

KW - Smoking

UR - http://www.scopus.com/inward/record.url?scp=22244474948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=22244474948&partnerID=8YFLogxK

U2 - 10.1097/01.mlr.0000167180.03824.fb

DO - 10.1097/01.mlr.0000167180.03824.fb

M3 - Article

C2 - 15970783

AN - SCOPUS:22244474948

VL - 43

SP - 683

EP - 690

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 7

ER -