Medicaid Prenatal Care

About 37,000 infants die in the United States each year, many unnecessarily. Low birth weight is a major contributor to infant death and is associated with higher initial medical costs for infants and long-term medical and special education costs for those who survive. Public funds pay for many of these expenses. This briefing report discusses (1) whether states are using Medicaid to improve access to prenatal care services and enhance services to poor women and what reported effect that may have on birth weight and infant mortality and (2) whether lessons have been learned about providing care for underserved populations that Congress should consider as it debates health care reform. GAO concludes that states have improved access to and beefed up the prenatal care provided to poor women by Medicaid. Although early indicators suggest a reduction in infant mortality and low birth weight rates, some health care proposals could undermine these efforts.

GAO found that: (1) since 1986, many states have used Medicaid to improve access and enhance prenatal care services for women, but states will face challenges in improving outcomes in the new health care environment; (2) enhanced services for Medicaid women have improved birth outcomes; (3) Medicaid managed care has had quality and access problems in the past; (4) if states want to improve infant health, they must focus on making managed care plans accountable for improving the health of the enrolled population; and (5) health care reform could bring changes in financing that could limit states' abilities to maintain enhanced services.