In low-income pregnant women, how does the use of Medicaid affect their pregnancy?
Ashley Morgan, Clara Wolf, Preston Pettit, Samantha Allen
Background
Daw, J. R., Winkelman, T. N. A., Dalton, V. K., Kozhimannil, K. B., & Admon, L. K. (2020). Medicaid expansion improved perinatal insurance continuity for low-income women. Health Affairs, 39(9), 1531-15.
Department of Health, Count Government of Kilifi, South Australia College of Medicine and Public Health, Flinders University, Director at Centre of Excellence in Women and Child Health, Aga Khan University, & Aga Khan University Hospital. (2019). Effects of Implementing Free Maternity Service Policy in Kenya: An Interrupted Time Series Analysis. 1-8
Dubay, L., Hill, I., Garrett, B., Blavin, F., & Johnston, E. (2020, June). Improving birth outcomes and lowering costs for - proquest. ProQuest.
Geiger, Sommers, B. D., Hawkins, S. S., & Cohen, J. L. (2021). Medicaid expansions, preconception insurance, and unintended pregnancy among new parents. Health Services Research, 56(4), 691–701.
Greiner, K. S., Speranza, R. J., Rincón, M., Beeraka, S. S., & Burwick, R. M. (2018, September 26). Association between insurance type and pregnancy outcomes in women diagnosed with hypertensive disorders of pregnancy. Taylor & Francis Online.
Johnston, McMorrow, S., Alvarez Caraveo, C., & Dubay, L. (2021). Post-ACA, More Than One-Third Of Women With Prenatal Medicaid Remained Uninsured Before Or After Pregnancy: Study examines insurance coverage and access to care before, during, and after pregnancy for women with prenatal Medicaid coverage. Health Affairs, 40(4), 571–578.
Leal, M. C., Esteves-Pereira, A. P., & Viellas, E. F. (2020). Prenatal Care in the Brazilian Public Health Services. 1-10.
Myerson, R., Crawford, S., & Wherry, L. R. (2020). Medicaid expansion increased preconception health counseling, folic acid intake, and postpartum contraception. Health Affairs, 39(11), 1883-14.
Barriers to appropriate prenatal care poses a larger concern because these patients are at a higher risk of adverse outcomes for infants as well as the mother.
In severe situations it poses a fatality risk towards the mother and baby.
Our Question
Article Summaries
Why is this important?
Conclusion/Recommendations
References
Findings:
Medicaid is an essential program for low income pregnant women.
Medicaid policies and expansions = improved outcomes of the pregnancy
The health disparities of our population will decrease
Recommendations:
Equity and inclusion of socioeconomic status
Advocating for further insurance coverage with Medicaid patients
Providing education about eligibility for Medicaid coverage
Affordable Care Act was passed in 2010, and it expanded eligibility for Medicaid for non-disabled adults under 65 that didn’t have minor children.
Medicaid expansion started in 2014, starting with 26 states & DC. Over the years, expansion has continued, and Medicaid is now available in 38 states & DC.
As of 2022, there are 21 million people that have enrolled in Medicaid due to the expansion of eligibility.
Prenatal care and health counseling is paramount to ensuring the best outcomes for pregnant women and neonates alike.
Lower proportion of women who received preconception health counseling, had adequate folic acid intake, and utilization of contraception before the expansion of Medicaid (Myerson, R., Crawford, S., & Wherry, L. R., 2020).
Pregnant women with Medicaid had a higher frequency of hypertensive disorders of pregnancy, as well as adverse outcomes for their neonates (Greiner et al. 2018).
Compare and Contrast
2
Article #1 vs. Article #7:
Article #1 discussed how the expansion of Medicaid increased the accessibility to perinatal care for more women, whereas Article #7 was comparing pregnancy outcomes based on private or public insurance.
Article #2 vs. Article #8:
Both of these articles address the expansion of Medicaid
One focuses on the proper use of prenatal folic acid and how to use contraception after giving birth.
The other discusses resources provided to achieve better outcomes.
1
3
4
5
6
7
Medicaid Expansion Improved Perinatal Insurance Continuity For Low-Income Women
Decrease in insurance churning during the perinatal period
Insurance continuity was improved for low-income women
Expansion provided easier access to prenatal care for low-income women
Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of ‘Strong Start For Mothers And Newborns’
(Daw, J. R., et al., 2020)
Medicaid paid for over 43% of pregnancies in 2017
Birth centers
Group prenatal care
Maternity care homes
Medicaid prenatal care provided an increase in positive pregnancy outcomes
(Dubay, L., et al., 2020
Association Between Insurance Type and Pregnancy Outcomes in Women Diagnosed with Hypertensive Disorders of Pregnancy
Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception
8
Women with hypertensive disorders of pregnancy, comparing outcomes based on insurance type
Study sample includes 13.2% of 10,132 deliveries, only including those that had a hypertensive disorder of pregnancy
54.1% had Medicaid, 44.1% had private insurance, and 1.8% had unknown insurance
Mothers that had Medicaid had more severe BP, more eclampsia cases, and ICU admissions
27,118 women in expansion states vs 23,094 in non-expansion states
After Medicaid expansion: 4% increase in preconception health counseling, 1.9% increase in folic acid intake, and a 3.8% increase in postpartum use of effective contraception for low-income pregnant women
11% increase in Medicaid coverage for women before pregnancy, 8.5% increase in postpartum Medicaid coverage
(Myerson, R., Crawford, S., & Wherry, L. R, 2020)
Post-ACA, More Than One-Third Of Women With Prenatal Medicaid Remained Uninsured Before Or After Pregnancy
Medicaid expansions, preconception insurance, and unintended pregnancy among new parents
(Geiger et al., 2021)
(Johnston et al., 2021)
Post ACA → significant decrease of uninsured women during the perinatal period
Although 34.5% of women with Medicaid were uninsured some point during perinatal period between 2015-2018
Further expansions are needed → ensure coverage during any point of the perinatal period
Medicaid expansion pregnancies → reported less financial stress before and during pregnancy → reduces poor pregnancy outcomes → reduces later life outcomes for children
Medicaid expansions = initiating care earlier in the pregnancy
In 2017 14.3% nulliparous parents reported having no insurance in the month before conception
Further policy development and expansions are needed
Effects of Implementing Free Maternity Service Policy in Kenya: An Interrupted Time Series Analysis
Studied the prenatal care that is provided = the effects on the pregnancy
Increase the affordability and access of prenatal care = decrease the amount of deaths associated with pregnancy
Conducted in 3 different countries in Kenya = 90 facilities
No evidence that change in policy can be associated with better outcomes of pregnancy
Increase in antenatal care coverage is increasing the amount of skilled care being provided during pregnancy
(Department of Health, County Government of Kilifi et al., 2019)
Prenatal Care in the Brazilian Public Health Services
Correlation between the care of the mother during her pregnancy = the outcome of the pregnancy and the newborn
Collected through surveys in 2018-2019
19,117 women who received public funding out of the 23,894 who had given birth within the designated year
Regional inequalities are present in Brazil as are barriers to access and adequate health care
These regional inequalities can be associated with problematic outcomes of the newborn
(Leal, M. C. et al, 2020)
(Dubay, L., et all., 2020, 1047)
Article #3 vs. Article #5:
Both discuss the need for medical coverage during pregnancy and dives into possible barriers for women to have adequate care
Article #5 differs in that a policy change was being studied to determine the outcomes, while #3 recommends further expansion of programs.
Article #4 vs. Article #6:
Both used surveys to interview women with government/public assisted births
Found inequalities within prenatal care → suggest further policy development is needed
One takes place in US whereas as another takes place in Brazil = differing policies