Preventing Infant Mortality Through Medicaid-Administered Prenatal Care Coordination: Evidence From Wisconsin.

Abstract

Objective: To estimate associations between Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program and infant mortality.

Data sources and study setting: We analyzed birth records, Medicaid claims, and infant death records for all resident and in-state Medicaid-paid live deliveries during 2010-2018.

Study design: We measured PNCC exposure during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt). Our outcome was infant mortality (death at age < 365 days). Adjusted binary logit regressions and propensity score weighted regressions tested associations between PNCC receipt and infant mortality, and we estimated probabilities and average marginal effects of infant mortality. We also executed regressions with interactions on maternal race/ethnicity to determine if associations varied across Black non-Hispanic (NH), Hispanic, and White NH births.

Data collection/extraction methods: Our sample consisted of 231,540 Medicaid-paid births during 2010-2018. PNCC is only available to pregnant Medicaid beneficiaries.

Principal findings: Infant mortality was lower among PNCC assessment/care plan only births (5.0 deaths/1000 births) and PNCC service receipt births (6.1 deaths/1000 births) relative to non-PNCC births (6.8 deaths/1000 births). This pattern was consistent in Black NH and Hispanic subgroups, but infant mortality did not vary by PNCC among White NH deliveries. Overall, adjusted binary logit regressions indicated that the probabilities of infant mortality were 0.70% for no PNCC and 0.53% for any PNCC, yielding an average marginal effect of -0.17 percentage points (95% confidence interval -0.22 percentage points, -0.11 percentage points). This association did not vary by PNCC exposure level. PNCC-infant mortality associations were significantly stronger for Black NH births relative to White NH births. Results were consistent in propensity score weighted regressions.

Conclusions: PNCC during pregnancy is associated with a lower probability of infant mortality, particularly in Black NH families. The benefit of PNCC on infant mortality may not depend on receiving services beyond care planning.