THE EFFECT OF EXPANDING MEDICAID PRENATAL SERVICES ON BIRTH OUTCOMES

Objectives. Over 80% of US states have implemented expansions in prena tal services for Medicaid-enrolled women, including case management, n utritional and psychosocial counseling, health education, and home vis iting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. Meth ods. The change in prenatal care use and low-birthweight rates among W ashington's Medicaid-enrolled pregnant women before and after initiati on of expanded prenatal services was compared with the change in these out-comes in Colorado, a control state. Results. The percentage of ex pected prenatal visits completed increased significantly, from 84% to 87%, in both states. Washington's low-birthweight rate decreased (7.1% to 6.4%, P=.12), while Colorado's rate increased slightly (10.4% to 1 0.6%, P=.74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P=.01, for adults; 22.5% to 11.5%, P=.03, for teenagers), especially t hose with preexisting medical conditions. Conclusions. A statewide Med icaid-sponsored support set-vice and case management program was assoc iated with a decrease in the low-birthweight rate of medically high-ri sk women.