title: Changes in North Carolina maternal health service use and outcomes among medicaid-enrolled pregnant women during state budget cuts.
abstract: OBJECTIVE
  The recent recession has weakened the US health and human service safety net. Questions about implications for mothers and children prompted this study, which tested for changes in maternal service use and outcomes among North Carolina women with deliveries covered through Medicaid before and after a year of significant state budget cuts.
  
  
  METHODS
  Data for Medicaid covered deliveries from April-June 2009 (pre) and from April-June 2010 (post) were derived from birth certificates, Medicaid claims and eligibility files, and WIC (Special Supplemental Food Program for Women, Infants and Children) records. These time periods represent the quarter immediately before as well as the final quarter of a state fiscal year 2010 (July 2009-June 2010) characterized by substantial state budget cuts, including an October 2009 reduction in reimbursement rates for maternity care coordination. We examined how often women received medical care, maternity care coordination, family planning services, and the average numbers of obstetrical encounters, as well as the prevalence of excessive pregnancy weight gain, preterm delivery, and low birth weight.
  
  
  RESULTS
  By the end of a year of substantial state budget cuts, women covered through Medicaid had fewer obstetrical visits in all trimesters as well as postpartum (P < .001). Maternal weight gain, preterm delivery, and low birth weight were stable.
  
  
  CONCLUSIONS
  One key aspect of medical service use decreased for women enrolled in Medicaid by the end of a year of major state health and human services budget cuts. Maternal and infant child health outcomes measured in this study did not change during that year. Future monitoring is warranted to ensure that maternal health service access remains adequate.
authors: Department of Maternal and Child Health, University of North Carolina at Chapel Hill (Dr Cilenti); Department of Health Policy and Management, Texas A & M University, College Station (Drs Kum and Wells); North Carolina State Center for Health Statistics, Raleigh (Dr Whitmire); RTI Health Solutions, Durham, North Carolina (Mr Goyal); and Department of Health Policy and Administration, Pennsylvania State University, University Park, State College (Dr Hillemeier).
authors: Dorothy
authors: D
authors: Cilenti
authors: Hye-Chung
authors: HC
authors: Kum
authors: Rebecca
authors: R
authors: Wells
authors: J Timothy
authors: JT
authors: Whitmire
authors: Ravi K
authors: RK
authors: Goyal
authors: Marianne M
authors: MM
authors: Hillemeier
mesh_terms: D000328:Adult; D002017:Budgets / Q000331:legislation & jurisprudence / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D012959:Socioeconomic Factors; D014481:United States