Published online October 23, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1509-e1515 (doi:10.1542/peds.2004-0489)
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ARTICLE

Poor Preventive Care Achievement and Program Retention Among Low Birth Weight Infant Medicaid Enrollees

Shanna Shulman, PhD

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts

OBJECTIVE. In this study, I examined the relative odds of achievement of preventive care goals during the first year of life and retention of Medicaid coverage at the end of the first year among Medicaid-enrolled low birth weight infants. Association with maternal prenatal health promotion was also considered.

METHODOLOGY. I used a retrospective case-control design. Low birth weight and normal birth weight infants in the Florida Medicaid program (1995–1999) matched on demographic factors were compared on their relative odds of achievement of preventive care goals and Medicaid program retention using multivariate logistic regression (n = 7510). A subsample of infants with linked maternal claims was used to measure the association of maternal health promotion during the prenatal period.

RESULTS. Low birth weight infants had lower relative odds of achieving preventive care goals during the first year and of retaining Medicaid coverage after the first year compared with infants of normal birth weight. However, when maternal health promotion during the prenatal care period was held constant, birth weight was no longer related to achievement of preventive care goals and program retention. Maternal health promotion was positively associated with achievement of preventive goals and program retention for all infants regardless of birth weight.

CONCLUSIONS. Some Medicaid-enrolled low birth weight infants are at risk for poor health supervision and poor continuity of care through failure to retain coverage. The disproportionate odds of poor health promotion among mothers of low birth weight infants explain much of this deficit. States may want to prioritize preventive care supervision and program reenrollment for children of mothers with evidence of low health promotion. This recommendation is particularly important for infants of low birth weight.

Key Words: Medicaid • maternal health promotion • program retention • preventive care

Abbreviations: AFDC—Aid to Families With Dependent Children • OBRA—Omnibus Budget Reconciliation Act • PCCM—primary care case management • HMO—health maintenance organization • ICD-9—International Classification of Diseases, Ninth Revision • AAP—American Academy of Pediatrics • OR—odds ratio • CI—confidence interval

Accepted May 30, 2006.


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