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Wayne A. Ray, PhD; Joseph Gigante, MD; Edward F. Mitchel, Jr, MS; Gerald B. Hickson, MD

JAMA. 1998;279:314-316.

Context.— The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care.

Objective.— To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994.

Design.— Before and after retrospective cohort analysis.

Setting and Population.— Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare).

Outcome Measures.— Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life.

Results.— Tennessee residents had 72014 study births in 1993 and 72278 in 1995, of which 37543 (52.1%) and 35707 (49.4%) were to women enrolled in Medicaid at delivery. For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years). These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women.

Conclusion.— Study perinatal outcomes did not change among Medicaid births following the transition to TennCare.

From the Departments of Preventive Medicine (Dr Ray and Mr Mitchel) and Pediatrics (Drs Gigante and Hickson), Vanderbilt University, Nashville, Tenn.

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