Impact of Statewide Mandatory Medicaid Managed Care (SMMC) Programs on Hospital Obstetric Outcomes

Abstract

The state of Florida implemented mandatory managed care for Medicaid enrollees via the Statewide Medicaid Managed Care (SMMC) program in April of 2014. The objective of this study was to examine the impact of the implementation of the SMMC program on the access to care and quality of maternal care for Medicaid enrollees, as measured by several hospital obstetric outcomes. The primary data source for this retrospective observational study was the Hospital Cost and Utilization Project (HCUP) all-payer State ED (SED) visit and State Inpatient Databases (SIDs) from 2010 to 2017. The primary health outcomes for obstetric care were primary cesarean, preterm birth, postpartum preventable ED visits, postpartum preventable readmissions, and vaginal delivery after cesarean (VBAC) rates. Using difference-in-differences (DID) estimation, selected health outcomes were examined for Florida residents with Medicaid beneficiaries (treatment) and the commercially insured population (comparison), before and after the implementation of SMMC. Improvement in disparities for racial/ethnic minority Medicaid enrollees was estimated relative to whites, compared to the relative change among commercially insured patients. From the DID estimation, the findings showed that SMMC is statistically significantly associated with a higher reduction in primary cesarean rates, preterm births, preventable postpartum ED visits, and readmissions among Medicaid beneficiaries relative to their commercially insured counterparts. However, this study did not find any significant reduction in racial/ethnic disparities in obstetric outcomes. In general, this study highlights the impact of SMMC implementation on obstetric outcomes in Florida and provides important insights and potential scope for improvement in obstetric care quality and associated racial/ethnic disparities.

Health Insurance Coverage and Postpartum Outcomes in the US

“…For the full report, our electronic searches yielded 25 973 citations (Figure). We screened 589 full-text articles, of which 28 studies, reported in 29 articles, were eligible for the current systematic review.…”

“…One study (Symum et al) reported on unplanned health care utilization (eAppendix 7 in Supplement 1). Florida’s Mandatory Medicaid Managed Care policy was associated with a lower rate of preventable readmissions (incidence rate ratio [IRR], 0.86; 95% CI, 0.80 to 0.93) and emergency department visits (IRR, 0.87; 95% CI, 0.82 to 0.93) by 1.5 months post partum …”

“…For the full report, our electronic searches yielded 25 973 citations ( Figure ). We screened 589 full-text articles, of which 28 studies, reported in 29 articles, 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 were eligible for the current systematic review.…”

“…All 28 included studies were nonrandomized comparative studies (published between 2008 and 2022) with adequate statistical adjustment analyses, comprising a total of 3 423 781 postpartum individuals (range 1184 to 1 454 699) (eAppendix 2 in Supplement 1 ). The studies were conducted in single states (or in the District of Columbia) (16 studies 24 , 25 , 27 , 29 , 31 , 32 , 33 , 35 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 51 , 52 ), 2 states (4 studies 34 , 37 , 48 , 49 ), or 5 or more states (8 studies 26 , 28 , 30 , 36 , 45 , 46 , 47 , 50 ). Fifteen studies focused on general postpartum care and 13 studies focused specifically on contraceptive care.…”

“…25 Thirteen studies evaluated the impact of policy changes that made insurance coverage more comprehensive. These included 9 studies of Medicaid expansion in various states 24,33,36,37,[39][40][41][42]44,52 ; 1 study that evaluated the impact of a law requiring hospitals to provide the option of long-acting reversible contraception (LARC) placement after delivery in Ohio 32 ; 1 that evaluated the impact of unbundling (ie, separate reimbursement for immediate postpartum LARC) in Wisconsin 29 ; 1 that evaluated the transition from…”