Beginning in July 2021, North Carolina Medicaid and the state’s Children’s Health Insurance Program (CHIP) transitioned from a fee-for-service system to risk-based managed care for most beneficiaries, including most parents, children, and pregnant women. Given the large role that Medicaid plays in maternal and infant health, it is important to document how this transition may affect the health of pregnant women and infants in North Carolina.
In this chartbook, we use 2018 natality data and 2015–18 Pregnancy Risk Assessment Monitoring System (PRAMS) data to establish baseline estimates of perinatal health for Medicaid beneficiaries in North Carolina before the transition to Medicaid managed care and the implementation of other Medicaid transformation initiatives.
Why This Matters
As North Carolina transitions to managed care in the Medicaid program and pursues other initiatives related to transforming the Medicaid delivery system, this research shows that special attention should be paid to opportunities to improve perinatal outcomes overall—particularly for Black mothers and births to Black women. These findings can be used to study the impacts of the transition.
What We Found
- In 2018, about 42 percent of North Carolina births were paid for by Medicaid, a similar share to the national average.
- More than two-thirds of births to Black and American Indian or Alaska Native mothers were paid
for by Medicaid, compared with less than one-third of white and Asian births.
- Black recent mothers in North Carolina were more likely than Hispanic and white recent mothers to have Medicaid coverage at each point of their pregnancy and to have continuous coverage from preconception to postpartum.
- Rates of timely prenatal care initiation among those with prenatal Medicaid coverage were lower than the rates among those with private prenatal coverage, and nearly 1 in 5 mothers with prenatal Medicaid coverage experienced inadequate prenatal care.
- Among Medicaid-paid births, rates of preterm birth and low birth weight (11.8 percent and 11.7 percent, respectively) were significantly higher than the Healthy People 2020 goals set by the Office of Disease Prevention and Health Promotion (9.4 percent and 7.8 percent, respectively).
- When compared with their white counterparts, Black women with prenatal Medicaid coverage had similar demographic and socioeconomic characteristics, access to care, and rates of prepregnancy and prenatal hypertension and diabetes. However, they had higher rates of low-birth-weight births, which suggests the existence of barriers beyond coverage and access, such as structural racism or discrimination.
How We Did It
This analysis uses 2018 natality data and 2015–18 PRAMS data to present baseline estimates of maternal demographic and socioeconomic characteristics; patterns of Medicaid coverage; access to care; and health outcomes before, during, and after pregnancy among North Carolina births. We investigate patterns by payer, race and ethnicity, and county in North Carolina, and for Medicaid beneficiaries in nonexpansion states and in the United States overall.