Perinatal outcomes following implementation of TennCare

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 in 1994. 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 72 014 study births in 1993 and 72 278 in 1995, of which 37 543 (52.1%) and 35 707 (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.