Health Reform Impacts On Maternal And Child Health
September 4, 2013

Medicaid Coverage For Births Highest In Southern States

April Flowers for - Your Universe Online

In 2010, 3.8 million babies were born in the United States. A new study from the George Washington University and the March of Dimes reveals that Medicaid paid for nearly half of those births. The findings, published in the journal Women’s Health Issues, demonstrate that the birth rate has been rising for a while, as well as offering the most comprehensive information to date on Medicaid financing of births in each of the 50 states and nationally.

The research team, led by Anne Markus, JD, PhD, MHS, an associate professor of health policy at the George Washington University School of Public Health and Health Services (SPHHS), say that their data will help other researchers gauge the impact of health reform on maternal and child health. Some states are expanding Medicaid under the Affordable Care Act (ACA) and this expansion may lead to improved coverage of well-woman and maternity care. Markus hopes that this will result in better health outcomes.

"As states expand coverage, low-income women of childbearing age will be able to obtain more continuous coverage before and between pregnancies," said Markus. "Now, for the first time, researchers will have a comprehensive baseline that will help them determine how increased access to services might change pregnancies and ultimately birth outcomes."

Prior to this study, data on Medicaid funding of births either did not exist in a comprehensive form, or were not reliable. The research team’s goal was to change that by collecting all such data on Medicaid births from individual states from 2008 to 2010.

In 2010, the team discovered that Medicaid paid for 48 percent of all births in the US. This was up from 40 percent in 2008, and represented a 19 percent increase in the proportion of all births financed by Medicaid and a 5 percent increase in the total number of Medicaid-financed births in just two years. Over the course of the study, Medicaid-financed births increased by 90,000.

The team hopes that their data will allow researchers to determine whether rates of Medicaid financing of births change in the coming years and whether there is a connection between Medicaid coverage and health outcomes. Future research, for example, would have the ability to determine if expanding Medicaid coverage before and between pregnancies leads to fewer high-risk or complicated pregnancies, and more healthy, full-term babies.

"About half a million babies are born prematurely in the United States every year," said March of Dimes President Dr. Jennifer L. Howse. "Some of these preterm births could be prevented with the appropriate care provided at the right time. Babies born premature are at risk for lifelong health problems and often require care in a hospital's Neonatal Intensive Care Unit. This study gives us a critical baseline to help chart the progress of health reform as it affects maternal and child health."

The key findings include:

• The percentage of Medicaid-funded births varied widely among states. In Hawaii, for example, only one-quarter of births were financed by Medicaid, while nearly 70 percent were funded in Louisiana.

• The lowest proportions of Medicaid-funded births were found in the northeastern and northwestern US. Massachusetts and New Hampshire had less than 30 percent of births funded by Medicaid, and Washington State reported 39 percent.

• The highest Medicaid coverage was found in southern states. More than 60 percent of all births were financed by Medicaid in 2010 in Arkansas, Louisiana, Mississippi, the District of Columbia and Puerto Rico.

States have the option to expand Medicaid and provide coverage to all low-income women, including those who are not pregnant under the ACA. In many cases, it will be the first time such women will be able to access health care before a pregnancy starts and between pregnancies. Prior studies have suggested that such services could improve the health of mothers-to-be and lead to better health outcomes for babies.

According to the study, better health outcomes might result in savings for state Medicaid programs. Investing in Medicaid-covered health care that occurs both before and between pregnancies might allow states to save money as a result of shorter hospital stays and less need for the expensive medical care required by complicated pregnancies or births.

"This study gives us a window into the vital role Medicaid plays in maternal and child health," said Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes. "With these data in hand, we'll be able to accurately monitor the impact of Medicaid expansion and other factors on the births covered by state Medicaid programs. The March of Dimes is proud to have partnered with George Washington University researchers in producing this landmark study."