Utilization of health and community services among pregnant women enrolled in Medicaid

Background: Our nation will provide health coverage for a greater number of women in their reproductive years under health reform. Yet, there is little understanding of how pregnant and postpartum women, currently covered by Medicaid, use health care. Objective: The objective of this study is to describe the utilization of medical care, Medicaid care coordination (enhanced prenatal services, EPS), and postpartum care among pregnant women enrolled in Medicaid. Methods: A statewide descriptive analysis of mother-infant pairs, singleton live births in 2009, was conducted using linked vital record, Medicaid expenditures, and EPS data from the Michigan Department of Community Health Data Warehouse. Results: Among the 62,052 mother-infant pairs, about 24% of all Medicaid insured women in Michigan received less than adequate (Kotelchuck) prenatal care (PNC). Forty-six percent of women had emergency department claims during pregnancy. Only 27% of women were enrolled in EPS care coordination. Although prenatal care providers make most EPS referrals (only 16% of women engage in EPS before PNC), only 24% women were enrolled in EPS in the month they initiated PNC. After delivery, only 40% of all women had evidence of a postpartum visit. About 51% of women remained on Medicaid for the first year post birth. Of women who dropped off Medicaid after birth, only 11% enrolled in Medicaid Family Planning Waiver program. Conclusion: Care for Medicaid insured pregnant women is underutilized and fragmented. A better organized system of care is needed, including integration of care coordination, to improve population health for women and infants.