M. Beth Benedict, DrPH, JD, Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, 867 DeFranceaux Harbour, Riviera Beach, MD 21122, 410-786-7724, bbenedict@cms.hhs.gov and Norma I. Gavin, PhD, Health, Social and Economics Research, Research Triangle Institute, P.O. Box 12194, Research Triangle Park, NC 27709.

An important purpose of this CMS sponsored, study of 217,897 pregnant women in Florida, Georgia, New Jersey and Texas was to assess the impacts of differences in care, costs, and outcomes explained by race, Medicaid disability eligibility, duration of enrollment in Medicaid, behavior, education, pre-existing health risk, pregnancy-related complications, or other factors. A disproportionately large percentage of disabled, pregnant women was Black non-Hispanic; a disproportionately small percentage was Hispanic. Hence, to understand the racial disparities in care and outcomes, these analyses focused on disabled, pregnant women. Multi-variate analyses, unadjusted and adjusted odds ratios with confidence levels and significant tests at the .05 level will be presented.

Compared to nondisabled, pregnant women the disabled were more likely to be enrolled in Medicaid before pregnancy, to seek early prenatal care and to have prescription vitamins; but they were less likely to have an adequate number of visits. The disabled were more likely to develop pregnancy-related complications and adverse maternal and newborn outcomes, to have a c-section, emergency room visits and hospitalizations before and after the delivery stay.

Generally, women from different racial/ethnic groups were equally likely to receive prenatal care. However, Black disabled women who used alcohol or smoked or had a drug dependence were less likely than white women with these behaviors to have had prenatal care. Overall, Hispanic disabled, pregnant women received less care and had lower total costs than either White or Black, disabled women. Black disabled, pregnant women were on average more costly and had poorer outcomes than White disabled women. These results have important meaning for maternal care in public health programs.

Learning Objectives: Upon completion of this presentation, the learner (participant) will be able to

1.Describe differences in maternal and infant outcomes that healthy, low-income or poverty enrolled women tend to experience as compared with the women enrolled in Medicaid as disabled.
• Discuss the impacts of the race/ethncity factor on the evidence of higher adverse outcomes among disabled women.
• Discuss the impacts of behavioral risk factors, pre-existing health conditions, length of enrollment in Medicaid and pregnancy complications on the higher adverse maternal and infants outcomes among the disabled, and in particular among the Black disabled women.

Keywords: Pregnancy Outcomes, Medicare/Medicaid

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: The data are from the Medicaid State Agencies to the Centers for Medicare and Medicaid Services federal research database.
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.