The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island

Objectives. The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid m anaged care program in Rhode Island. Methods. Rhode Island birth certificate data (1993-1995; n = 37021) were us ed to analyze pre- and post-program implementation changes in adequacy of p renatal care utilization. Logistic regression models were used to character ize the variation in prenatal care adequacy as a function of both time and the various covariates. Results. Adequacy of prenatal care utilization for Medicaid patients improv ed significantly after implementation of the program, from 57.1% to 62.1% ( odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3), After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive ade quate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). Conclusions. Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode island has resulted in significant improvement i n adequacy of prenatal care utilization for its enrollees. This improvement nas due to specific program interventions that addressed and changed organ izational and delivery system barriers to care.