Surveying hard-to-reach programs: identifying the population of Medicaid prenatal case management programs

Community-based prenatal case management (PCM) is a means to improve birth outcomes for medically or socially high-risk pregnant women. To conduct national surveys of PCM programs, a useful sampling frame of existing programs is needed. However, as a relatively small optional Medicaid reimbursed program, PCM programs are hard to reach. Methodological approaches are needed to address issues arising when attempting to access and survey hard-to-reach participants, including programs.

State Medicaid offices were contacted to determine whether they reimbursed for PCM, and lists of Medicaid providers were obtained from those states. Most providers on the lists were contacted to confirm that they provide PCM and to verify the program director contact information.

Multiple attempts, using different modes of communication, were required to identify states reimbursing for PCM through Medicaid (n = 33). Of providers on the lists obtained from 29 of the 33 states, 34% of those listed provided PCM, suggesting over coverage rather than omissions. Provider contact information was outdated, duplicative, or not specific to PCM. The final count was 1,184 PCM programs in 29 states.

Identifying hard-to-reach programs requires persistence and creativity, as well as a rigorous approach to generating a census of programs.