High-Risk Pregnancies and Health Conditions in Medicaid-Insured Participants in a Federal Healthy Start Program [13F

Abstract

INTRODUCTION: Decreasing disparities in maternal morbidity and mortality and addressing maternal chronic health conditions in Medicaid-insured pregnant women are important national goals. Federal Healthy Start (HS) programs provide care for underserved and racial/ethnic minority women, many with self-reported medical conditions, and address social determinants; an opportunity for strategic partnerships with clinical providers. The study objective was to use administrative data and describe health conditions and compare risks in a cohort of HS participants with a statewide population of Medicaid-insured women. METHODS: Medicaid-insured HS participants (N=389) were compared with Michigan beneficiaries (N=80,547). Linked Medicaid claims and vital record data were used to identify health conditions and high-risk pregnancy; AHRQ’s Clinical Classification Software diagnoses were used to identify behavioral health conditions and assess multiple health conditions during pre-pregnancy and pregnancy periods. IRB determined the study did not involve human subjects. RESULTS: HS participants were significantly more likely to have high-risk pregnancy claims (67.4% vs 30.2%), mental health conditions (31.9% vs. 20.2%), multiple health conditions (61% vs. 49%), prior preterm birth (6.7% vs. 3.7%), less than 12 grade education/health literacy (41.6% vs. 16.9%) and be African American (54% vs. 29%). There was a trend for chronic hypertension (5.7% vs. 4%), but no group differences for chronic diabetes (5.7% vs. 5.8%). CONCLUSION: Findings support that HS, equipped to address cultural and social determinants, serves many Medicaid-insured women with multiple, complex health problems, high-risk pregnancies, and mental health issues. Standard processes for program referral and coordination within practices who provide prenatal care could optimize services for high-risk women.