Elsevier

Women's Health Issues

Volume 23, Issue 5, September–October 2013, Pages e273-e280
Women's Health Issues

Policy matters
Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform

https://doi.org/10.1016/j.whi.2013.06.006Get rights and content

Abstract

Background

Medicaid is a major source of public health care financing for pregnant women and deliveries in the United States. Starting in 2014, some states will extend Medicaid to thousands of previously uninsured, low-income women. Given this changing landscape, it is important to have a baseline of current levels of Medicaid financing for births in each state. This article aims to 1) provide up-to-date, multiyear data for all states, the District of Columbia, and Puerto Rico and 2) summarize issues of data comparability in view of increased interest in program performance and impact assessment.

Methods

We collected 2008–2010 data on Medicaid births from individual state contacts during the winter of 2012–2013, systematically documenting sources and challenges.

Findings

In 2010, Medicaid financed 48% of all births, an increase of 19% in the proportion of all births covered by Medicaid in 2008. Percentages varied among states. Numerous data challenges were found.

Conclusions/Implications for Research and Policy

Consistent adoption of the 2003 birth certificate in all states would allow the National Center for Health Statistics Natality Detail dataset to serve as a nationally representative source of data for the financing of births in the United States. As states expand coverage to low-income women, women of childbearing age will be able to obtain coverage before and between pregnancies, allowing for access to services that could improve their overall and reproductive health, as well as birth outcomes. Improved birth outcomes could translate into substantial cost savings, because the costs associated with preterm births are estimated to be 10 times greater than those for full-term births.

Section snippets

Introduction and Background

The Medicaid program is a major source of public financing for health care services provided to pregnant women, infants, and children in the United States. In 2012, the program covered 35% of all children, including infants, as well as a significant number of deliveries across the nation (Kaiser Commission on Medicaid and the Uninsured, 2013). Hospital discharge data analyzed for the Agency for Healthcare Research and Quality indicate that Medicaid paid for 44.4% of complicated deliveries and

Methods

In an effort to update the available information on Medicaid-funded births and supplement the NCHS payer data anticipated for release in 2013, we collected 2008–2010 data on Medicaid births from individual state contacts during the winter of 2012–2013. Our priority with the individual state data collection was to gather birth frequencies for the 17 states that have not adopted the 2003 birth certificate, because their Medicaid births are not reflected in the NCHS dataset, although we were able

State-Based Medicaid Birth Estimates

In 2010, Medicaid financed approximately 48% of births in the United States. The proportion of births financed by Medicaid varied substantially among states, with fewer than one quarter of births financed by Medicaid in Hawaii (24%) and nearly 70% financed by Medicaid in Louisiana (Table 2).

Overall, northeastern and northwestern states in the United States tend to have the lowest proportion of births financed by Medicaid, whereas southern states tend to have the highest proportions of

Discussion

Our research shows that none of the current reporting systems is ideal, each with its own challenges and limitations. In addition, the use of three different data collection and reporting systems cannot yield reliable national figures and limits the consistency in the reported numbers. Consistent adoption of the 2003 certificate in all states would allow the NCHS Natality Detail dataset to serve as a nationally representative source of data for the financing of births in the United States, once

Acknowledgments

We are grateful for support provided by the March of Dimes.

Anne Rossier Markus, JD, PhD, MHS, is Associate Professor in the Department of Health Policy of the George Washington University's School of Public Health and Health Services. Anne directs the Department's child health policy research and analysis portfolio and focuses on topics related to the financing and organization of health care and access to quality care, with a special emphasis on domestic and international policies that affect women and children's health and well-being.

References (19)

  • Agency for Healthcare Research and Quality. (2012). Healthcare Cost and Utilization Project (HCUP), 2012. Available at:...
  • Dailard, C. (2002). New SCHIP prenatal care rule advances fetal rights at low-income women's expense. The Guttmacher...
  • Guttmacher Institute. (2013). State data center. Retrieved from...
  • M. Heberlein et al.

    Getting into gear for 2014: Findings from a 50-state survey of eligibility, enrollment, renewal, and cost-sharing policies in Medicaid and CHIP, 2012–2013

    (2013)
  • Preterm birth: Causes, consequences and prevention

    (2006)
  • Kaiser Commission on Medicaid and the Uninsured. (2012), Where are states today: Medicaid and CHIP eligibility levels...
  • Medicaid: A primer

    (2013)
  • Kaiser Family Foundation. (2011). Women’s Health Care Chartbook: Key Findings from Kaiser Women’s Health Survey....
  • Kaiser Family Foundation. (2012). Medicaid’s role for women across the lifespan: Current issues and the impact of the...
There are more references available in the full text version of this article.

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Anne Rossier Markus, JD, PhD, MHS, is Associate Professor in the Department of Health Policy of the George Washington University's School of Public Health and Health Services. Anne directs the Department's child health policy research and analysis portfolio and focuses on topics related to the financing and organization of health care and access to quality care, with a special emphasis on domestic and international policies that affect women and children's health and well-being.

Ellie Andres, MPH, DrPH-c, is a Senior Research Associate and doctoral candidate in the Department of Health Policy of the George Washington University's School of Public Health and Health Services. Her research interests include maternal and child health, community health centers, and policies that affect women, such as the Family and Medical Leave Act of 1993.

Kristina D. West, JD, MS Health Policy Candidate is a Senior Research Associate at the Department of Health Policy, School of Public Health and Health Services, The George Washington University. Her research interests are in maternal and child health policy.

Nicole Garro, MPH, Director of Public Policy Research at the March of Dimes, oversees the March of Dimes' maternal and child health policy research agenda, which informs advocacy for programs and policies that promote positive health outcomes for women and children.

Cynthia Pellegrini, BA, is Senior Vice President for Public Policy and Government Affairs at the March of Dimes, responsible for guiding March of Dimes advocacy efforts at the federal level and in all 50 States, the District of Columbia and Puerto Rico.

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