Context.— The abrupt initiation of capitated Medicaid care in Tennessee (TennCare)
in 1994 prompted many questions about changes in quality of care.
Objective.— To evaluate the effect on perinatal outcomes of the transition to TennCare
Design.— Before and after retrospective cohort analysis.
Setting and Population.— Births to women residing in Tennessee between 1990 and 1995 with complete
demographic information on birth certificates, with a focus on women enrolled
in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare).
Outcome Measures.— Late prenatal care (after the fourth month of pregnancy) or inadequate
prenatal visits, low and very low birth weight, and death in the first 60
days of life.
Results.— Tennessee residents had 72014 study births in 1993 and 72278 in 1995,
of which 37543 (52.1%) and 35707 (49.4%) were to women enrolled in Medicaid
at delivery. For these Medicaid births, there were no changes after TennCare
in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995),
inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%),
very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6%
both years). These findings were unchanged in multivariate analysis, in analysis
of high-risk subgroups, and in analysis of women with demographics characteristic
of Medicaid women.
Conclusion.— Study perinatal outcomes did not change among Medicaid births following
the transition to TennCare.