Lisa Dubay, Sc.M. and Genevieve M. Kenney, Ph.D.

Lisa Dubay and Genevieve Kenney are principal research associates at The Urban Institute in Washington, D.C. Lisa Dubay is a health services researcher with more than 20 years of public health experience. Genevieve Kenney is a health economist with more than twenty years of experience conducting research. Over the course of two HCFO grants, Dubay and Kenney have examined the ways in which policy changes in the Medicaid program have affected prenatal care and birth outcomes.

In their first HCFO study, and with more recent data in their second study, Dubay and Kenney examined whether mandating Medicaid expansions at the national level and allowing states to expand eligibility beyond the mandates increases access to prenatal care and improves birth outcomes. They found that the Medicaid expansions for pregnant women led to broad improvements in the prenatal care delivery system, such as the streamlining of the Medicaid eligibility determination process, increased provider payments, an infusion of federal dollars into the system, and an expansion in the capacity of the system. The expansions also resulted in a substantial increase in Medicaid-covered births and a reduction in uninsurance among low-income pregnant women, leading to significant improvements in the timely initiation of prenatal care. However, few improvements in birth outcomes were observed.

“This study illustrates that targeted expansions in the Medicaid program can reduce the rate of uninsurance without substantial substitution of public for private coverage and can improve access to care for low-income populations,” says Dubay. “Clearly such expansions in coverage are a necessary step towards improving the health of low-income populations.” However, the emerging lesson from the Medicaid expansions is that increased access to primary care is not sufficient, she says, if the goal is to narrow the gap in newborn health between low and higher-income populations.

In a second project, Dubay and Kenney built on the previously funded project to continue analyses at the national level, while also performing state-specific analyses (Ohio and Missouri) to examine the direct impacts of different managed care arrangements and financial risk structures on prenatal care use and birth outcomes. This research was featured during a recent HCFO Cyber Seminar.

Their research indicated that the effects of Medicaid managed care on prenatal care were mixed, depending on state-specific environments. “We learned that managed care and coverage expansions related to pregnancy are not a panacea,” says Kenney. “Managed care and other interventions occurring during the prenatal care period may have only a limited impact because so many women do not become eligible for or enroll in Medicaid until after they are pregnant.” Kenny believes that policymakers will have to look beyond managed care if they are to identify strategies that will improve birth outcomes for women covered by Medicaid.

Dubay and Kenney found no evidence of improvements in birth outcomes, and they could not rule out the possibility that Medicaid managed care had an adverse effect on outcomes in some states. In Ohio and Missouri, managed care was associated with reductions in smoking during pregnancy (impacts on smoking during pregnancy were not assessed in the national analysis). However, in both cases, rates of smoking among Medicaid women remained high.

Dubay and Kenney’s research portfolio has primarily focused on the effects of public policies on access and coverage for low-income populations. As co-directors of The Urban Institute’s multi-year evaluation of the State Children’s Health Insurance Program (SCHIP), they are examining a range of issues, including family coverage policies and SCHIP financing; participation in Medicaid and SCHIP and barriers to enrollment; access and use differentials among low-income children; effects on children of family coverage expansions; and impacts of SCHIP expansions on insurance coverage, crowd-out, and access to care.

Dubay is currently a doctoral student at the Johns Hopkins University’s Bloomberg School of Public Health. She received an Sc.M. in health policy and management from the Harvard School of Public Health and a B.A. from Tufts University.

Kenney received a Ph.D. in economics and an M.A. in statistics from the University of Michigan. She earned a B.A. from Smith College.

Articles and Reports from HCFO-Funded Projects.

Ellwood, M. and G. Kenney. “Medicaid and Pregnant Women: Who Is Getting Covered and When?” Health Care Financing Review, Vol. 17, No. 2, Winter 1995.

Dubay, L. et al. “Local Responses to Medicaid Expansions to Pregnant Women,” Milbank Quarterly, Vol. 73, No. 4, Winter 1995, pp. 535-64.

Norton, S. et al. “Medicaid Coverage of Maternity Care for Aliens in California,” Family Planning Perspectives, Vol. 28, No. 3, May/June 1996.

Dubay, L. and G. Kenney. “Did the Medicaid Expansions for Pregnant Women Crowd-out Private Insurance?” Health Affairs, Vol. 16, No. 1, January/February 1997.

Dubay, L. et al. “Changes in Prenatal Care Timing and Low Birth Weight by Race and Socioeconomic Status: Implications for Medicaid Expansions for Pregnant Women,” Heath Services Research, June 2001.

Kenney, G. and L. Dubay. “National Impacts of the Medicaid Expansions for Pregnant Women,” Urban Institute Working Paper, June 1997.

Kaestner, R. et al. “Medicaid Managed Care and Infant Health: A National Evaluation,” National Bureau of Economic Research, May 2002.

Sommers, A. et al. “The Implementation of Mandatory Medicaid Managed Care in Missouri: Impacts for Pregnant Women and Infants,” draft manuscript, January 2003.

Howell, E. et al. “The Impact of Medicaid Managed Care on Pregnant Women in Ohio: A Cohort Analysis,” Health Services Research, forthcoming.

Kenney, G. et al. “Moving to Mandatory Medicaid Managed Care in Ohio: Impacts for Pregnant Women and Infants,” draft manuscript, March 2003.

Howell, E. and A. Sommers. “The Implementation of Medicaid Managed Care for Pregnant Women in Ohio: A Case Study,” The Urban Institute, July 14, 2003. Available at: www.urban.org/url.cfm?ID=410823.