The effect of expanding Medicaid prenatal services on birth outcomes.
OBJECTIVE
Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates.


METHODS
The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state.


RESULTS
The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states. Washington's low-birthweight rate decreased (7.1% to 6.4%, P = .12), while Colorado's rate increased slightly (10.4% to 10.6%, P = .74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P = .01, for adults; 22.5% to 11.5%, P = .03, for teenagers), especially those with preexisting medical conditions.


CONCLUSIONS
A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women.
Baldwin
L M
LM
Department of Family Medicine, University of Washington, Seattle 98195-4696, USA. lmb@u.washington.edu
Larson
E H
EH
Connell
F A
FA
Nordlund
D
D
Cain
K C
KC
Cawthon
M L
ML
Byrns
P
P
Rosenblatt
R A
RA
D000293:Adolescent; D000328:Adult; D000385:Aid to Families with Dependent Children / Q000331:legislation & jurisprudence*; D019090:Case Management / Q000706:statistics & numerical data; D003120:Colorado; D005260:Female; D006302:Health Services Research; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008484:Medicaid / Q000331:legislation & jurisprudence*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000191:economics* / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012944:Social Support; D013221:State Health Plans; D014481:United States; D014861:Washington