Academic journal article Health Care Financing Review

Improving State Medicaid Programs for Pregnant Women and Children

Academic journal article Health Care Financing Review

Improving State Medicaid Programs for Pregnant Women and Children

Article excerpt

Improving State Medicaid programs for pregnant women and children


Beginning in the latter months of 1986, States made the reduction of infant mortality a paramount policy priority. As progress on major maternal and infant health indicators has slowed and, in some instances even reversed, States have taken advantage of numerous Federal Medicaid options to implement creative and innovative efforts to enhance low-income women's access to prenatal care and to improve the content of that care.

Acting first on new optional authorities to expand Medicaid eligibility up to and above the Federal poverty level, States have continued to improve programs by streamlining and simplifying eligibility systems, enhancing outreach and public information campaigns, attempting to recruit and retain adequate numbers of obstetrical providers to care for low-income pregnant women and children, and adding enriched nonmedical prenatal benefits to their State plans. Although the specific impact of these initiatives will not be known until formal evaluations are concluded, early anecdotal evidence indicates that State efforts are succeeding in making Medicaid programs both more accessible and effective.

Eroding health of American infants

States and the Nation's Governors have been forced to address the health care needs of mothers and infants because of two inescapable truths: First, the problems of infant mortality and low birth weight have reached "crisis" proportions throughout the country, and second, improving access to preventive prenatal care represents both a wise policy and a sound fiscal investment.

The positive effects of early, effective, and comprehensive prenatal care are well known. Increased use contributes directly to reduced incidence of infant mortality and babies born at low birth weight (Buescher, 1988 Efird, 1988 Meglen, 1987 van Dyck, 1987 Ward, 1988). The good news is that such preventive services are relatively inexpensive, an average of $400 for an uncomplicated pregnancy. Some research also suggests that an investment in prenatal care is cost-effective--an estimated savings for more than $3 is possible for every dollar spent on prenatal care for pregnant women at high risk of delivering a low-birth-weight baby (Institute of Medicine, 1985).

If prenatal care is not received, however, the consequences can be grave from both human and cost perspectives. Women who do not obtain sufficient prenatal care are about twice as likely (10 percent versus 5 percent) to have a low-birth-weight baby and more than 1 1/2 times more likely to have their babies prematurely (13 percent versus 8 percent) than are women who receive adequate prenatal care (Gold et al., 1987). If a women receives no prenatal care, her likelihood of having a low-birth-weight baby is three times greater (U.S. General Accounting Office, 1987 Hughes et al., 1988).

Low birth weight, defined as 5 1/2 pounds or less, is the single factor most commonly associated with the death and disability of newborns. Low-birth-weight babies are 40 times more likely to die during their first month of life than are babies who weigh more. If they do survive, they are twice as likely to suffer one or more disabilities during their lifetime (Southern Regional Task Force on Infant Mortality, 1985). The infant mortality rate in 1986 was 10.4 deaths per 1,000 live births in the United States, placing this country behind 17 other industrialized Nations when rank-ordering this measure. For black newborns, the infant mortality rate is nearly twice as high--18.0 deaths per 1,000 live births (Hughes et al., 1989).

Although nationally the average cost of an uncomplicated pregnancy resulting in a normal delivery is estimated at $2,900, these costs balloon to an average of $12,000 if birth is premature with major complications. If the infant is extremely premature, the average costs rise to $27,000 (Gold et al. …

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