Racial and Geographic Variation of Prenatal Care Coordination Receipt in the State of Wisconsin, 2010-2019

Abstract

Medicaid-funded obstetric care coordination programs supplement prenatal care with tailored services to improve birth outcomes. It is uncertain whether these programs reach populations with elevated risks of adverse birth outcomes-namely non-white, highly rural, and highly urban populations. This study evaluates racial and geographic variation in the receipt of Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program during 2010-2019. We sample 250,596 Medicaid-paid deliveries from a cohort of linked Wisconsin birth records and Medicaid claims. We measure PNCC receipt during pregnancy dichotomously (none; any) and categorically (none; assessment/care plan only; service receipt), and we stratify the sample on three maternal characteristics: race/ethnicity, urbanicity of residence county; and region of residence county. We examine annual trends in PNCC uptake and conduct logistic regressions to identify factors associated with assessment or service receipt. Statewide PNCC outreach decreased from 25% in 2010 to 14% in 2019, largely due to the decline in beneficiaries who only receive assessments/care plans. PNCC service receipt was greatest and persistent in Black and Hispanic populations and in urban areas. In contrast, PNCC service receipt was relatively low and shrinking in American Indian/Alaska Native, Asian/Pacific Islander, and white populations and in more rural areas. Additionally, being foreign-born was associated with an increased likelihood of getting a PNCC assessment in Asian/Pacific Islander and Hispanic populations, but we observed the opposite association in Black and white populations. Estimates signal a gap in PNCC receipt among some at-risk populations in Wisconsin, and findings may inform policy to enhance PNCC outreach.

Keywords: Care coordination; Medicaid; Prenatal care; Regionalization..

Figure 1.

Map of Wisconsin with counties classified by urbanicity and clustered into regions Notes: We used the National Center for Health Statistics urban-rural classification scheme to code county urbanicity. Additionally, we used the Wisconsin Department of Health Services region classification to cluster counties into regions as denoted by thick black lines that outline regional perimeters.

Figure 2.

Prenatal Care Coordination receipt during pregnancy among Medicaid-paid deliveries in Wisconsin during 2010-2019 (N=250,596 deliveries) Notes: We used the National Center for Health Statistics urban-rural classification scheme to code the urbanicity of maternal residence county. The only large central metro county in Wisconsin is Milwaukee County. Additionally, we used the Wisconsin Department of Health Services region classification to code the region of maternal residence county. When stratifying Prenatal Care Coordination receipt by race/ethnicity, we excluded deliveries in which the birth record coded the mother as multiple race non-Hispanic or other race non-Hispanic (N=8,354 deliveries). “AI/AN” American Indian/Alaska Native; “NH” non-Hispanic; “PI” Pacific Islander.

Figure 3.

Prenatal Care Coordination service receipt among Medicaid-paid deliveries in Wisconsin during 2010-2019 in which the mother received a service assessment during pregnancy (N=56,865 deliveries) Notes: We used the National Center for Health Statistics urban-rural classification scheme to code the urbanicity of maternal residence county. The only large central metro county in Wisconsin is Milwaukee County. Additionally, we used the Wisconsin Department of Health Services region classification to code the region of maternal residence county. When stratifying Prenatal Care Coordination receipt by race/ethnicity, we excluded deliveries in which the birth record coded the mother as multiple race non-Hispanic or other race non-Hispanic (N=1,924 deliveries). “AI/AN” American Indian/Alaska Native; “NH” non-Hispanic; “PI” Pacific Islander.

Figure 4.

Annual Prenatal Care Coordination assessment and service receipt among Medicaid-paid deliveries in Wisconsin during 2010-2019 (N=250,596 deliveries) Notes: “PNCC” Prenatal Care Coordination.

Figure 5.

Annual Prenatal Care Coordination assessment and service receipt among Medicaid-paid deliveries in Wisconsin during 2010-2019, stratified by maternal race/ethnicity (N=242,242 deliveries) Notes: We excluded deliveries in which the birth record coded the mother as multiple race non-Hispanic or other race non-Hispanic (N=8,354 deliveries). “NH” non-Hispanic; “PNCC” Prenatal Care Coordination.

Figure 6.

Annual Prenatal Care Coordination assessment and service receipt rates among Medicaid-paid deliveries in Wisconsin during 2010-2019, stratified by urbanicity of maternal residence county (N=250,596 deliveries) Notes: We used the National Center for Health Statistics urban-rural classification scheme to code the urbanicity of maternal residence county. As noted in the figure, the only large central metro county in Wisconsin is Milwaukee County. “PNCC” Prenatal Care Coordination.

Figure 7.

Annual Prenatal Care Coordination assessment and service receipt rates among Medicaid-paid deliveries in Wisconsin during 2010-2019, stratified by region of maternal residence county (N=250,596 deliveries) Notes: We used the Wisconsin Department of Health Services region classification to code the region of maternal residence county. “PNCC” Prenatal Care Coordination.