Prenatal Care:

Medicaid Recipients and Uninsured Women Obtain Insufficient Care

HRD-87-137: Published: Sep 30, 1987. Publicly Released: Oct 28, 1987.

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Pursuant to a congressional request, GAO investigated the extent to which Medicaid beneficiaries and uninsured women experience difficulties in obtaining access to prenatal care to determine the: (1) timing and number of their prenatal care visits; and (2) barriers they perceived as preventing them from obtaining care earlier or more often.

GAO found that: (1) 63 percent obtained insufficient prenatal care; (2) those women most likely to obtain insufficient care were uninsured, poorly educated, black or Hispanic teenagers, or women from large urban areas; (3) those most likely to obtain adequate care were well-educated, white, residing in rural communities, in their early 30's, or Medicaid recipients; (4) lack of money to pay for care, lack of transportation, and unawareness of the pregnancy prevented women from obtaining earlier or more frequent prenatal care; (5) there was little information on the effectiveness of states' and communities' initiatives for improving access to prenatal care; (6) 19 states expanded Medicaid eligibility to pregnant women, although none implemented presumptive eligibility; (7) if states expanded Medicaid coverage of pregnant women, reduced intensive care and long-term institutional costs would offset initial costs; (8) increases in Medicaid reimbursement rates for maternity services would not improve access to care as much as expanding eligibility; and (9) states believed that Maternal and Child Health block grants were insufficient for needed prenatal services.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Congress has required states to expand eligibility to 100 percent of the poverty level.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, Health Care Financing Administration (HCFA), to develop and provide to states data on the: (1) increased costs they would likely incur in expanding Medicaid eligibility to include pregnant women with incomes up to 100 percent of the federal poverty level; and (2) corresponding decrease in costs for newborn intensive care and long-term institutional care they could expect to result from improvements in prenatal care services.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: A report in process shows that many states have now implemented presumptive eligibility.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, HCFA, to work with states to overcome the administrative problems that prevent them from adopting the presumptive eligibility provisions of the Omnibus Budget Reconciliation Act of 1986.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: Because of the variety of alternative actions taken to publicize programs to improve access to prenatal care, this recommendation is being dropped.

    Recommendation: The Secretary of Health and Human Services should direct the Surgeon General to expand efforts to evaluate programs to improve access to prenatal care and disseminate the results of these evaluations through the National Maternal and Child Health Clearinghouse.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Not Implemented

    Comments: The Department of Health and Human Services (HHS) has indicated no plans to implement this recommendation.

    Recommendation: The Secretary of Health and Human Services should direct the Surgeon General to provide technical assistance to communities in developing comprehensive plans for identifying the most important barriers to care in the community and designing programs to help overcome those barriers.

    Agency Affected: Department of Health and Human Services

 

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