Medicaid Managed Care in Two States: Findings from Two Studies to Evaluate Effects on Prenatal Care Use, Smoking, and Infant Birth Weight

Anna S. Sommers, Urban Institute
Lisa Dubay, Urban Institute
Genevieve Kenney, Urban Institute
Embry Howell, Urban Institute

The past two decades have seen broad expansions of Medicaid to pregnant women and greater reliance on the use of managed care. Few evaluations have examined whether Medicaid managed care affects prenatal care access and birth outcomes. In separate studies of Missouri and Ohio, enrollees in counties that implemented managed care were compared to enrollees in counties that remained fee-for-service before and after implementation. Dependent variables included prenatal care measures, smoking, and birth weight measures. Regression controlled for enrollment, medical risks, demographics, and county fixed effects. Analysis is supported by information from site visits. We found fewer improvements in adequate care, reductions in smoking, and no change in birth outcomes associated with Medicaid managed care in Missouri, and no impact in Ohio, where non-Medicaid cohorts were available for comparison. We identify limitations for improving care and birth outcomes given current Medicaid eligibility policies for pregnant women.