January 2001

Grant Results

National Program

Changes in Health Care Financing and Organization

SUMMARY

From 1991 to 1996, investigators at Harvard Medical School examined the effects of Medicaid eligibility expansions on a range of maternal and neonatal outcomes in California and South Carolina.

This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO) (for more information see Grant Results).

Key Findings

  • The research team found that the Medicaid expansions in California and South Carolina had only a limited effect on health outcomes for both mothers and infants.
  • The investigators concluded (as they had in an earlier Massachusetts study, RWJF grant ID# 017039) that health insurance coverage expansion alone does not appear to be enough to positively affect access to prenatal care or health outcomes.

Funding
RWJF supported this project through two grants totaling $516,023.

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THE PROBLEM

Under an earlier HCFO grant (ID# 017039), this research team looked at the effects of a statewide program in Massachusetts that expanded Medicaid coverage to pregnant women with household incomes just above the Medicaid eligibility level of 185 percent of the federal poverty level. Because of the similarities between Massachusetts' Healthy Start and the Medicaid program, the researchers argued that the findings could be generalized to other expansions of Medicaid.

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THE PROJECT

In this study, the investigators examined the effects of Medicaid eligibility expansions on a range of maternal and neonatal outcomes in California and South Carolina. The four-month planning grant allowed the research team to identify California and South Carolina as suitable states for an in-depth study because of their sizable urban and rural populations, comprehensive hospital discharge databases, and differing approaches to implementation of Medicaid eligibility expansion.

For both states, the investigators linked hospital discharge data for all maternity cases with vital statistics data on each woman's prenatal care and health outcomes. The discharge data included information on the payer, the patient's medical diagnosis, and her utilization of health care services. They examined additional state databases to compare pregnancy outcomes for women who were uninsured or newly eligible for Medicaid with the outcomes of women who had private health insurance.

The researchers also looked at variations in outcomes by race and other socio-demographic characteristics. The adverse infant outcomes addressed by the study included low birthweight and prematurity; the adverse maternal outcomes included a prolonged maternal length of stay that exceeded the infant's length of stay. The study also examined changes in Cesarean section rates before and after the Medicaid expansion.

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FINDINGS

The research team found that the Medicaid expansions in California and South Carolina had only a limited effect on health outcomes for both mothers and infants. In California, rates of initiation of prenatal care in the first trimester actually deteriorated after the expansion, while rates of low birthweight and prematurity showed marginal improvement. In South Carolina, there was a small positive impact on access to prenatal care and no effect on either maternal or infant outcomes.

The investigators drew a conclusion that echoed their conclusion in the earlier Massachusetts study: health insurance coverage expansion alone does not appear to be enough to positively affect access to prenatal care or health outcomes. They cautioned that their findings on California and South Carolina are just that — findings relevant to California and South Carolina. They have suggested that it would be helpful to examine other states for a broader understanding of the effect of Medicaid expansion. The investigators noted that further studies are needed on outcome and issues of access to care due to changes in the Medicaid program as it shifts to managed care.

Communications

An article entitled "Impact of Medicaid Expansion on Early Prenatal Care and Health Outcomes" was published in Health Care Financing Review, 19(4): Summer, 1998. See the Bibliography for details.

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GRANT DETAILS & CONTACT INFORMATION

Project

Effect of Expanding Medicaid Coverage on Health Outcomes

Grantee

Harvard Medical School (Boston,  MA)

  • Amount: $ 33,598
    Dates: November 1991 to February 1992
    ID#:  017811

  • Amount: $ 482,425
    Dates: March 1992 to February 1996
    ID#:  019672

Contact

Project Director : Arnold M. Epstein, M.D., M.A.
(617) 432-3415

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Publications

Epstein AM and Newhouse JP. "Impact of Medicaid Expansion on Early Prenatal Care and Health Outcomes." Health Care Financing Review, 19(4): 85–99, 1998. Available online.

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Report prepared by: Karin Gillespie
Reviewed by: Marian Bass
Reviewed by: Molly McKaughan
Program Officer: Nancy L. Barrand

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