MEDICAID AND NON-MEDICAID PRENATAL-CARE BY NURSE-MIDWIVES

The purpose of the study was to compare high-risk pregnant women with medical assistance payment (HRMA) and those with private insurance pay ment (HRPI) on use of provider time, care coordination activities, and financial reimbursement Comparisons were also conducted for the same factors between the high-risk and low-risk women (LRMA) that received medical assistance payment for their care. Total time spent by care pr oviders in giving antepartum, intrapartum, and postpartum care was hig hest for the HRPI women. However, the two medical assistance groups st arted prenatal care significantly later and had fewer visits, and one- third did not return for their 6-weeks postpartum visit. The HRPI grou p also had a higher cesarean birth rate. Rates of care coordination ac tivities such as calls, referrals, and consultations were significantl y higher for the HRPI and HRMA women compared with those for the LRMA women. However, the HRMA women have limited financial and psychosocial resources that require additional provider management and referrals. Reimbursement rate was highest for the HRPI group in which approximate ly 73% of the total amount billed was collected compared with approxim ately 56% among medical assistance women. Recommendations for policy, practice, and further research are offered.