1. Statewide Medicaid Managed Care Prenatal Report
Produced by the Medicaid Data Analytics – Business Intelligence Unit
Presented by Rachel La Croix, Medicaid Quality Bureau

2. Florida Medicaid – Snapshot
Florida Medicaid currently serves 3,916,609 enrollees.1
In 2015, there were an estimated total 224,273 births in Florida.2
In 2015, Medicaid funded 51.5% of all births in Florida.3
1Agency for Health Care Administration, Florida Statewide Medicaid Monthly Enrollment Report, October 2016.
2 Florida Department of Health, Division of Public Health Statistics & Performance Management, Births (count) by Year of Birth by County of Residence (Mother), October 2016.
3 Agency for Health Care Administration, Division of Medicaid, Bureau of Medicaid Data Analytics, October 2016.

3. Quarterly Statewide Medicaid Managed Care Report – Autumn 2016
Focus: Prenatal Care received by a cohort of women who were pregnant during first year of the Managed Medical Assistance Program.
Report describes:
Amount & timing of prenatal care received throughout pregnancy
Characteristics of deliveries
MMA plan provider networks for facilities and physicians who provide services for pregnant women
Percentage of each MMA plan’s reported networks that provided a service to cohort members during the review period

4. Quarterly Statewide Medicaid Managed Care Report – Autumn 2016
Establishes a baseline for assessing the adequacy of women’s access to prenatal care in the MMA program.
A future report will look at birth outcomes of the cohort.

5. Data Sources
Enrollment Information from the Florida Medicaid Managed Information System (FMMIS) Eligibility Information (October 2013-September 2015)
MMA Encounter and Claims Information from FMMIS (October 2013-September 2015)
MMA Provider Information from the Provider Network Verification (PNV) System (August 2014-September 2015)

6. Cohort Specifications
Pregnant women between the ages of 10 and 60 with a pregnancy or delivery-related service
Enrolled in an MMA plan at any time between August 1, 2014 and July 31, 2015 and pregnant at some point during that period
Pregnancy cohort = 169,375 women (14.4% of all women aged enrolled in MMA plans during the time period)
Study population = 113,224 members of the cohort who had a delivery by end of September 2015 (67% of the cohort)

7. Analysis Parameters
Pregnancy-related services examined for 10 months prior to month of delivery
Pregnancy-related services: practitioner visits (e.g., obstetricians or certified nurse midwives), birth center and lab services, and deliveries
Gestational age not available in the data – first month of pregnancy estimated to be nine months prior to delivery month
Prenatal care assessed by determining whether prenatal visits occurred in the delivery month and each of the 9 months before delivery

8. Cohort Characteristics
Majority between the ages of 19 and 32.
Average age = 25.5 years
Race/ethnicity of cohort (169,375 women):
36.1% of women identified as White
31.4% of women identified as Black
26.3% of women identified as Hispanic
Study population (113,224 women)
For women who delivered within the first 9 months of cohort period, a portion of the pregnancy was covered by Medicaid prior to SMMC implementation
Over half of the women – not enrolled in Medicaid 9 months prior to delivery
87% of the women – enrolled in Medicaid by 6 months prior to delivery
74% of women – enrolled in MMA plans for 4 or more months of their pregnancy. 29% were enrolled in MMA plans for 7 months or more.

9. Women with a Delivery who Had a Prenatal Visit by Month of Pregnancy, October 2013-September 2015
94% of women had at least one prenatal care visit during pregnancy
< 29% had a prenatal visit each month 7 or more months before delivery
48-66% had prenatal visits each month 4-6 months before delivery
70-85% had prenatal visits each month during the delivery month and 3 months prior

10. Of women that received a prenatal visit:
Earliest Month during Pregnancy with a Prenatal Visit, October 2013-September 2015
Of women that received a prenatal visit:
30% had first visit 7-9 months prior to delivery
49% had first visit 4-6 months prior to delivery
14% had first visit 1-3 months prior to delivery
70% had their first prenatal care visit later than the recommended 7 months prior to delivery

11. Number of Months between First Pregnancy-Related Service and First Prenatal Visit, October 2013-September 2015
Of the women that received a prenatal visit:
76% had first prenatal visit in same month or month following their first pregnancy-related service
Only 8% waited longer than two months past first pregnancy-related service to receive their first prenatal visit

12. Continuity of Prenatal Care
Only 30% of women began prenatal care in 1st trimester
78.4% of women had at least one prenatal care visit in the 2nd trimester
92% of women received a prenatal care visit in the 3rd trimester
28.7% had at least one prenatal visit in all three trimesters of pregnancy
15% had one or more prenatal visits only in the 3rd trimester

13. Number of Consecutive Months with at Least One Prenatal Visit in the Seven Months Prior to Delivery, October 2013-September 2015
85% of women received prenatal visits for less than the recommended 7 consecutive months prior to delivery.
71% had no more than two months without a prenatal visit between their first pregnancy-related service and the month of delivery.
72.6% missed no more than one month of prenatal visits after their 1st prenatal visit.
After first prenatal visit, 44% received a prenatal visit every month until delivery.

14. Enrollment in each Month of Pregnancy of Women with a Delivery and No Prenatal Care Visits, October 2013-September 2015
Six months before delivery, >20% of women without a prenatal care visit were enrolled in MMA plans. 40% were in FFS.
Three months prior to delivery, 60% were enrolled in MMA plans, 30% were in FFS. Less than 10% had yet to enroll in Medicaid.

15. Month of First Pregnancy-Related Service for Women with a Delivery, October 2013-September 2015
Six months prior to delivery or before, 72% of the women had received a service identifying their pregnancy.
Less that 11% had their first pregnancy-related service in the delivery month or three months prior.
Over half of women with a delivery had a pregnancy-related service early enough to allow prenatal visits to begin 7 months prior to delivery and continue in each month through delivery, yet only 15% achieved this recommendation.

16. Earliest Month of MMA Plan Enrollment during Pregnancy for Women with a Delivery, October 2013-September 2015
37% of the women enrolled in MMA plans during the delivery month or 3 months prior.
Just over 61% enrolled in MMA plans 4 months or more prior to delivery.
22% of women were enrolled in MMA plans early enough for plans to cover 7 months of prenatal visits prior to delivery.

17. Enrollment and Prenatal Visits of Women with a Delivery by Month of Pregnancy, October 2013-September 2015
Seven months before delivery, more than half of women who received prenatal care visits were covered by FFS.
Four months before delivery, over 60% of women who received prenatal care visits were covered by MMA plans rather than FFS.

18. Number of Months Between First Pregnancy-Related Service and MMA Plan Enrollment for Women with a Delivery, October 2013-September 2015
63% of women were already enrolled in MMA plans by the time they had their first pregnancy-related service or enrolled within 2 months of the service.

19. Key Findings
70% of women with a delivery had 1st prenatal care visit later than the recommended 7 months prior to delivery
21% of women with a delivery only had prenatal care in the 3rd trimester or no prenatal care
85% of women with a delivery received prenatal visits for fewer than the recommended 7 consecutive months before delivery
Lack of prenatal care could NOT be explained by a late identification of the pregnancy by the first pregnancy-related service, late enrollment in Medicaid, or late enrollment in an MMA plan

20. Quarterly Statewide Medicaid Managed Care Report – Autumn 2016
Report available online: