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Poor preventive care achievement and program retention among low birth weight infant Medicaid enrollees
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA. sshulman@mathematica-mpr.com
Insights
Maternal health promotion significantly impacts preventive care and Medicaid retention for low birth weight infants. Focusing on prenatal health support improves outcomes for all infants, regardless of birth weight.
Area of Science:
- Pediatric Health
- Health Services Research
- Public Health Policy
Background:
- Low birth weight infants enrolled in Medicaid face challenges in achieving preventive care goals.
- Retention of Medicaid coverage is crucial for ongoing health supervision for these infants.
- Maternal prenatal health promotion is a potential factor influencing infant health outcomes and coverage continuity.
Purpose of the Study:
- To examine the odds of achieving preventive care goals in the first year of life for Medicaid-enrolled low birth weight infants.
- To assess the retention of Medicaid coverage at the end of the first year for these infants.
- To investigate the association between maternal prenatal health promotion and these outcomes.
Main Methods:
- Retrospective case-control study design comparing low birth weight and normal birth weight infants in the Florida Medicaid program (1995-1999).
- Multivariate logistic regression used to compare odds of preventive care goal achievement and Medicaid retention (n=7510).
- Analysis of linked maternal claims data to assess prenatal health promotion's impact.
Main Results:
- Low birth weight infants had lower odds of achieving preventive care goals and retaining Medicaid coverage compared to normal birth weight infants.
- When maternal prenatal health promotion was controlled, birth weight was not significantly associated with preventive care or Medicaid retention.
- Maternal health promotion positively correlated with preventive care goal achievement and Medicaid retention for all infants.
Conclusions:
- Medicaid-enrolled low birth weight infants are at risk for inadequate health supervision and care continuity.
- Maternal prenatal health promotion deficits significantly contribute to poorer outcomes for low birth weight infants.
- Prioritizing preventive care and re-enrollment support for children whose mothers exhibit low health promotion is recommended, especially for low birth weight infants.
Objective:
In this study, I examined the relative odds of achievement of preventive care goals during the first year of life and retention of Medicaid coverage at the end of the first year among Medicaid-enrolled low birth weight infants. Association with maternal prenatal health promotion was also considered.
Methodology:
I used a retrospective case-control design. Low birth weight and normal birth weight infants in the Florida Medicaid program (1995-1999) matched on demographic factors were compared on their relative odds of achievement of preventive care goals and Medicaid program retention using multivariate logistic regression (n = 7510). A subsample of infants with linked maternal claims was used to measure the association of maternal health promotion during the prenatal period.
Results:
Low birth weight infants had lower relative odds of achieving preventive care goals during the first year and of retaining Medicaid coverage after the first year compared with infants of normal birth weight. However, when maternal health promotion during the prenatal care period was held constant, birth weight was no longer related to achievement of preventive care goals and program retention. Maternal health promotion was positively associated with achievement of preventive goals and program retention for all infants regardless of birth weight.
Conclusions:
Some Medicaid-enrolled low birth weight infants are at risk for poor health supervision and poor continuity of care through failure to retain coverage. The disproportionate odds of poor health promotion among mothers of low birth weight infants explain much of this deficit. States may want to prioritize preventive care supervision and program reenrollment for children of mothers with evidence of low health promotion. This recommendation is particularly important for infants of low birth weight.
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