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Research
Results and Policy Context
Research
Results
Genevieve
Kenney, Ph.D. – Urban Institute – and colleagues (1)
studied the impact of the move to Medicaid managed care on prenatal
care and birth outcomes nationally and in two states. E. Kathleen
Adams, Ph.D. – Emory University – and colleagues (2)
examined whether low-income women are less likely to be insured
prior to and during pregnancy as a result of the Personal Responsibility
and Work Opportunity Reconciliation Act’s (PRWORA) de-coupling
of cash assistance from Medicaid and whether decreased Medicaid
enrollment due to PRWORA resulted in delayed prenatal care.
Kenney
and colleagues found that the effects of Medicaid managed care on
prenatal care were mixed, depending on state specific environments
and differences in implementation. A key finding was that managed
care was associated with reductions in smoking during pregnancy,
but that rates of smoking among Medicaid-covered women remained
high. Their research also confirmed earlier work showing that Medicaid
eligibility and coverage expansions for pregnant women promoted
earlier prenatal care. However, neither managed care nor coverage
expansions had any measurable positive effect on birth outcomes.
Adams found that even prior to PRWORA (welfare reform) pregnant
women experienced more transition and change in insurance status
than anticipated and the end result of PRWORA was that more low-income
women were uninsured prior to pregnancy. The study provided evidence
that welfare reform led to less take-up and delayed take-up of Medicaid
benefits. Adams and colleagues also simulated a variety of potential
policy reforms and found that the intervention most likely to have
an effect on early prenatal care and, potentially, birth outcomes
would be an expansion of private insurance for low-income women
prior to pregnancy.
Both
of these studies support the contention that the timing of Medicaid
enrollment is critical, and policy interventions promoting earlier
insurance coverage for pregnant women could have a beneficial effect
on initiation of prenatal care and, potentially, birth outcomes.
The need to confirm a pregnancy and the finite period of pregnancy
limit the potential of the Medicaid expansions and other Medicaid
interventions to affect outcomes. This limitation may be compounded
by the fact that health status at the time of pregnancy and one’s
desire to be pregnant are factors that have been associated with
the timing of prenatal care, (3, 4)
although the findings regarding adverse outcomes are not consistent.
(5)
Policy
Context
The
policy discussion began with a moderated discussion with Debbie
Chang, currently at the National Academy of State Health Policy
and formerly Maryland’s Medicaid Director, and Rachel Benson
Gold of the Alan Guttmacher Institute. Chang and Gold reacted to
the research findings, placing them in a “real world”
context. They then discussed whether the research results reflect
the experience of those working in the states and the affected populations.
They also discussed the implications of the findings for policy
and operations and identified additional questions to which state
officials need answers. Following the moderated discussion, participants
in the Cyber Seminar were able to ask questions and make comments
of their own by phone or through the virtual chat room.
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1
Lisa Dubay, ScM, (Co-Principal Investigator), Principal Research
Associate, The Urban Institute; Embry Howell, Ph.D., Principal Research
Associate, The Urban Institute; Anna Sommers, M.A. Research Associate,
The Urban Institute; and Robert Kaestner, Ph.D. Professor, Department
of Economics and Institute of Government and Public Affairs, The
University of Illinois at Chicago.
2
Norma I.Gavin, Ph.D., Director of Maternal, Child and Reproductive
Health Program at the Research Triangle Institute; Arden Handler,
Dr.Ph., Community Health Sciences, School of Public Health, University
of Chicago at Illinois; Will Manning, Ph.D., Professor, Department
of Health Studies, University of Chicago; and Cheryl Raskind-Hood,
M.P.H., Research Professor, Rollins School of Public Health.
3
Centers for Disease Control and Prevention, Unintended Childbearing:
Pregnancy Risk Assessment Monitoring System-Oklahoma, 1988-1991.
Mortality and Morbidity Weekly Report (MMWR), Volume 41, 1992.
4
Kost, K., Landry, D.J., and Darroch, J.E., Predicting Maternal
Behaviors During Pregnancy: Does Intention Status Matter? Family
Planning Perspectives, Volume 30, No. 2, Alan Guttmacher Institute,
March/April 1998.
5
Colley-Gilbert B., Brantley, M.D., Larson, M.K., Family Planning
Practices and Pregnancy Intention, 1997. Division of Reproductive
Health, National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention, 2000.
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