Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1148-1154 (doi:10.1542/peds.2004-2584)
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Medicaid Acceptance and Availability of Timely Follow-up for Newborns With Medicaid

Alison A. Galbraith, MD, MPH*, David C. Grossman, MD, MPH{ddagger},§,||, Thomas D. Koepsell, MD, MPH§,¶,#, Patrick J. Heagerty, PhD#,** and Dimitri A. Christakis, MD, MPH||,#,{ddagger}{ddagger},§§

* Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts
{ddagger} Department of Preventive Care and Center for Health Studies, Group Health Cooperative, Seattle, Washington
§ Health Services
|| Pediatrics
Epidemiology
# Robert Wood Johnson Clinical Scholars Program
** Department of Biostatistics
{ddagger}{ddagger} Child Health Institute, University of Washington, Seattle, Washington
§§ Children's Hospital and Regional Medical Center, Seattle, Washington

Objective. Decreased physician participation in Medicaid has been shown to affect adversely timeliness of adult acute care and pediatric specialty care, but it is not clear whether this is the case for newborn follow-up. The objectives of this study were to determine whether there is a difference within clinics in the timeliness of follow-up appointments that are given to newborns with Medicaid compared with newborns with private insurance and to determine whether there is a difference between clinics that do and do not accept Medicaid in the timeliness of appointments that are given for newborn follow-up.

Methods. A randomized crossover study was conducted among general pediatric clinics and practices that were identified from the yellow pages and Internet searches of hospitals and health departments in 8 metropolitan areas from September 2003 to March 2004. A simulated parent telephoned clinics to find the earliest available appointment for a 1-day-old infant who needed routine follow-up after discharge that day. Clinics were randomly assigned to receive a first call from a patient with either Medicaid or private insurance; each clinic received the same call at least 3 weeks later with the patient's insurance status reversed. The main outcome measure was whether the appointment was timely (≤2 days from the day of the call).

Results. Of 401 participating clinics, 22% did not accept Medicaid. Among clinics that accepted Medicaid, availability of a timely appointment for a newborn with Medicaid was similar to that for a newborn with private insurance (87% vs 90%, respectively). Appointments that were provided to privately insured newborns were as likely to be timely in clinics that accept Medicaid as in clinics that do not accept Medicaid (89.5% vs 93.4%, respectively). However, providing timely appointments was significantly less likely in clinics that were in high-poverty locations compared with clinics that were not (86.1% vs 92.7%, respectively).

Conclusions. Although newborns with Medicaid did not have access to >20% of clinics because of their insurance, among clinics that did accept Medicaid, timeliness of available follow-up was similar for newborns with Medicaid compared with newborns with private insurance and similar between clinics that did and did not accept Medicaid. However, to the extent that care for newborns with Medicaid is concentrated in clinics in high-poverty areas, some newborns with Medicaid may not be able to receive timely appointments.

Key Words: access to health care • insurance • Medicaid • newborn

Abbreviations: AAP, American Academy of Pediatrics • CI, confidence interval

Accepted Jan 24, 2005.