Since Medicaid paid for 45 percent of the 4 million births in the United States in 2010, and that has been rising steadily, a new paper says that the Affordable Care Act (ACA) and expanding Medicaid even more may lead to improved coverage of well-woman and maternity care — and perhaps result in better health outcomes.

Previously, data on Medicaid funding of births did not exist in a comprehensive form so the authors collected all such data on Medicaid births from individual states during the years 2008 to 2010.

They discovered that in 2010 Medicaid paid for 45 percent of all births in the United States, up from 43 percent of Medicaid covered births in 2008. That represents a 4 percent increase in the proportion of all births financed by Medicaid in just two years.

Under the ACA, states have the option to expand Medicaid and provide coverage to all low-income women, including those who are not pregnant. Those women will be able to access health care before a pregnancy starts and between pregnancies. Previous research suggests that such services could improve the health of mothers-to-be and lead to better health outcomes for babies.

The authors believe that better health outcomes could result in savings for state Medicaid programs. If states invest in Medicaid-covered health care that occurs both before conception and between pregnancies they may be able to save money as a result of shorter hospital stays and less need for the expensive medical care required by complicated pregnancies or births, the article says.

"As states expand coverage, low-income women of childbearing age will be able to obtain more continuous coverage before and between pregnancies," said lead author of the study Anne Markus, JD, PhD, MHS, an associate professor of health policy at the George Washington University School of Public Health and Health Services (SPHHS). "Now, for the first time, researchers will have a comprehensive baseline that will help them determine how increased access to services might change pregnancies and ultimately birth outcomes."  

Their hope is that researchers will be able to use such data to determine whether rates of Medicaid financing of births change in the coming years and whether there is a connection between Medicaid coverage and health outcomes. For example, future studies would be able to examine whether expanding Medicaid coverage before and between pregnancies leads to fewer complicated pregnancies and more healthy, full-term babies. 

"About half a million babies are born prematurely in the United States every year," said March of Dimes President Dr. Jennifer L. Howse. "Some of these preterm births could be prevented with the appropriate care provided at the right time. Babies born premature are at risk for lifelong health problems and often require care in a hospital's Neonatal Intensive Care Unit. This study gives us a critical baseline to help chart the progress of health reform as it affects maternal and child health."

Other key findings from the study:

• The percentage of births paid for by Medicaid varied substantially among states. For example, just one quarter of births in Hawaii were financed by Medicaid compared to nearly 70 percent in Louisiana.

• States in the northeastern and northwestern United States have the lowest proportion of births financed by Medicaid. For example, Massachusetts and New Hampshire reported fewer than 30 percent of births funded by Medicaid, and Washington State reported 39 percent.

• Southern states tend to have the highest Medicaid coverage: For example, Arkansas, Louisiana, Mississippi, the District of Columbia and Puerto Rico each reported 60 percent or more of all births financed by Medicaid in 2010.

"This study gives us a window into the vital role Medicaid plays in maternal and child health," said study co-author Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes. "With these data in hand, we'll be able to accurately monitor the impact of Medicaid expansion and other factors on the births covered by state Medicaid programs."

Citation: Anne Rossier Markus, JD, PhD, MHS, Ellie Andres, MPH, DrPH-c, Kristina D. West, JD, Nicole Garro, MPH, Cynthia Pellegrini, 'Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform', Women's Health Issues Volume 23, Issue 5 , Pages e273-e280, September 2013 doi:10.1016/j.whi.2013.06.006