Impacts of Medicaid Privatization on Prenatal Care Utilization in Iowa

BACKGROUND: Early and adequate prenatal care is associated with improved maternal and infant health outcomes. In Iowa, a switch to Managed Care Organizations (MCOs) for Medicaid recipients in 2016 was intended to increase care provision, particularly for rural Iowans. This study examines whether prenatal care initiation in the first trimester and adequacy of prenatal care improved following the MCO transition, and whether this varied by rurality. METHOD: Birth certificate data for 236,034 births in Iowa from 2013 to 2019 were provided by the Iowa Department of Health & Human Services. This sample included 90,440 Medicaid paid births; 37,898 occurred before MCO implementation (2013-2015), and 39,499 occurred after (2017-2019). Generalized additive models were used to examine relationships between early and adequate care and sociodemographic attributes in the pre-MCO and post-MCO phases. Potential variation in MCO impacts by rurality of birth parent residence was also assessed. RESULTS: Among Medicaid paid births, early initiation of prenatal care was stable across the pre-MCO (77.26%) and post-MCO (77.23%) period, as was adequate prenatal care use (80.70% pre-MCO versus 79.22% post-MCO transition), and both outcomes varied according to sociodemographics. The post-MCO transition period was not associated with a change in odds of early care initiation but was associated with 5.8% lower odds of adequate care use (OR = 0.942, CI 0.902, 0.984). Among rural parents in the post-MCO transition period, there was a 11.5% (OR = exp(0.020+ 0.089) = 1.115) higher odds of initiating care early compared to the pre-MCO transition period. Rural parents did not experience any significant differences in adequate care use after MCO implementation. CONCLUSION: While the period following the MCO transition improved prenatal care initiation among rural parents, additional geographic and sociodemographic barriers must be identified and addressed to ensure the maintenance of prenatal care throughout pregnancy.