Prenatal, Delivery, and Infant Care under Medicaid in Three States
Howell, Embry M., Brown, Gretchen A., Health Care Financing Review
Prenatal, delivery, and infant care under Medicaid in three States
Medicaid services and expenditures were analyzed for care during the prenatal, delivery, and post-delivery periods in three States--California, Georgia, and Michigan. Uniform data were used from the Health Care Financing Administration's Medicaid Tape-to-Tape project, 1983-84. Results indicate that from 16 to 24 percent of all births in the States of the study, during the study period, were financed by Medicaid. Overall, the study showed that more than one-half of expenditures for the study population were for the delivery hospitalization, and less than 12 percent were for prenatal care. As expected, a substantial portion of expenditures were for high-cost deliveries, up to 41 percent of total delivery payments. From 33 to 41 percent of total Medicaid expenditures for Aid to Families with Dependent Children were for pregnancy, delivery, and newborn care in 1983.
The Medicaid program is the Nation's primary source of financing medical care for low-income women and their children. A lack of uniform reporting systems across States has hindered efforts to perform comparative analyses of Medicaid expenditures for pregnancy and infant care. In addition to a lack of information on expenditures, relatively little has been known about the actual number of women and infants who receive Medicaid services and the types of Medicaid services they receive.
Information presented in this article is from the Medicaid Tape-to-Tape project (Health Care Financing Administration, 1983-84). The Tape-to-Tape project contains unique, person-based information on all services covered by Medicaid since 1980 in several States.
In this study, Medicaid-financed deliveries from California, Georgia, and Michigan for the month of October 1983 were identified, and health services expenditure measures were developed and analyzed. We divided services associated with these deliveries into three periods: prenatal (January 1983 through the date preceding delivery admission); delivery hospitalization; and post-delivery (date following delivery hospitalization discharge through October 31, 1984).
This study complements previously analyzed aggregate, cross-sectional Medicaid data on services related to pregnancy and infant care by analyzing person-based data. Information from this analysis may be useful in current policy debates on financing of cost-effective health services for low-income pregnant women and infants.
Goals of the study
The purpose of this study was twofold. Because relatively little information is available on utilization of and expenditures associated with pregnancy and post-delivery care under Medicaid, we designed this study to demonstrate the possibility of using Medicaid secondary data files to further study such care. Using those data files, we provide additional information on the following aspects of Medicaid-financed pregnancy and post-delivery care: * The number of deliveries covered by Medicaid. * The volume and type of Medicaid services received
by women during the prenatal period. * The Medicaid charges and payments for those
services. * The length of stay, charges, and payments for
delivery hospitalizations financed by Medicaid. * The type and volume of Medicaid services received
by women and their infants during the post-delivery
period. * Total Medicaid expenditures for prenatal, delivery,
and post-delivery care.
Review of previous studies
The Alan Guttmacher Institute (AGI) has conducted a number of studies on the role of the Medicaid program in the financing of pregnancy and infant care. Based on data from the 1984 Current Population Survey, Gold and Kenny (1985) of AGI report that 9 percent of women of childbearing age receive publicly funded support through Medicaid. Their analysis also found that in 1984 Medicaid covered only 43 percent of women of childbearing age whose annual family income was less than $5,000 and 31 percent of those with incomes between $5,000 and $9,999. …