Access to prenatal care for soon-to-be mothers on Medicaid differs considerably across states, according to new federal research.
More than two-thirds of women began prenatal care during the first trimester of their pregnancy, according to new research presented by the Medicaid and CHIP Payment and Access Commission's staff at a meeting on Friday. Over three-quarters of pregnant women on Medicaid received at least nine prenatal care visits.
But access to prenatal care was all over the map. Just over half of the women in Washington, D.C. started prenatal care during their first trimester compared to 85% of expecting moms in Vermont. State-level differences appear to have a significant impact on access to prenatal care. There's no apparent urban-rural divide, according to Martha Heberlein, a principal analyst for MACPAC.
Medicaid financed 43% of all U.S. births in 2018, but the percentage varied significantly across states. The program covered 25% of births in North Dakota compared to 63% in Mississippi and Louisiana. Medicaid covered a larger share of births in rural areas, but mothers in urban areas made up 84% of Medicaid-financed births.
Nearly all births occurred in a hospital setting, a trend that was consistent across all states. Doctors attended 90% of births compared to 9% for certified nurse midwives.
MACPAC's staff found that nearly one in three births covered by the program resulted in a cesarean section delivery. Preterm births made up 11% of Medicaid deliveries, and 10% of infants were low birthweight.
"(We should be concerned about) the enormous public health impact of low birthweight and both the short-term and long-term impacts on morbidity and the Medicaid program itself," said Dr. Peter Szilagyi, professor of pediatrics and executive vice-chair of the Department of Pediatrics at the Mattel Children's Hospital at the University of California, Los Angeles.
MACPAC members are interested in learning more about maternal mortality and postpartum care under the Medicaid program, especially maternal suicide and drug overdose. But there's a critical lack of data available on maternal mortality and other aspects of maternal health, according to MACPAC's staff.
"We're really not measuring one of the main factors we care about," said Martha Carter, founder and former CEO of FamilyCare Health Centers.
That's mainly due to inconsistencies in what data states collect and how they collect it, said MACPAC's staff. Even when states collect information about maternal death, it's challenging to figure out whether Medicaid paid for the birth and if the cause of death was related to the pregnancy, said Heberlein.
MACPAC will discuss new research on maternal morbidity at its meeting next month.
