Evaluation of California's statewide implementation of enhanced perinatal services as Medicaid benefits.

The authors evaluated enhanced perinatal services developed by public health specialists that were implemented statewide through specially certified Medicaid providers to find out whether they were as effective as those services originally tested in the public health agency's pilot project, and more effective than services from regular Medicaid providers. Multivariate logistic regression analyses yielded adjusted odds ratios of use of care and health outcome measures for the statewide services compared with both the pilot project and routine Medicaid care. Although women receiving the enhanced services implemented statewide did not return for prenatal visits as well as those in the pilot project, they did better than women with routine Medicaid providers. Women who kept at least the eight prenatal visits recommended by the Public Health Service in 1989 had risks of low weight births no different from those in the pilot project and significantly better than those for women with at least eight visits with routine Medicaid providers (adjusted odds ratio 0.70 with a 95 percent confidence interval from 0.54 to 0.91). Thus, there is evidence for the efficacy of the services, but additional improvement could be realized through improving the use of care.