Association for Public Policy Analysis & Management

Substance use disorders (SUDs) among pregnant women have serious consequences for maternal and infant health. As Medicaid covers a disproportionate share of these births, describing care received by Medicaid-covered pregnant women with SUDs is critical to understanding gaps in timely diagnosis and treatment. Few studies have empirically examined medical care for pregnant women with SUDs. This research analyzes prevalence and specificity of SUD-related diagnoses, timing of first SUD-related diagnosis and treatment, and maternal and infant costs across three state Medicaid programs.

Study Design:

This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after birth occurring in 2014 or 2015. Diagnosis and procedure codes identify SUD-related diagnoses.

Population Studied:

The study population was women with Medicaid claims data from 2013-2016 who gave birth to a live singleton infant in 2014 or 2015, were enrolled in full-benefit Medicaid for at least one month, and had valid data on infant birthweight and gestational age. The final sample size was 37,782 for 2014 and 34,304 for 2015.

Principal Findings:

During the study period, 3.6% of women had a specific SUD diagnosis (e.g. alcohol use disorder) first observed before or during the birth month (“early diagnosis”), 1.7% had a specific SUD diagnosis first observed after the birth month (“late diagnosis”), and 6.0% had an unspecified SUD-related diagnosis (e.g., drug withdrawal) in the year before and after giving birth (“unspecified diagnosis”). Nearly half of women with a late diagnosis received it more than three months after giving birth. Women with an early diagnosis were more likely to have enrolled in Medicaid 10-12 months before the birth month (60.9%), compared to 55.4% among women with a late diagnosis and 49.6% among women with an unspecified diagnosis. Women with an early or late diagnosis were more likely to get SUD treatment, 59.9% and 63.1% respectively, compared to only 28.6% among women with an unspecified diagnoses. Women with an early diagnosis had a far higher rate of timely treatment (20.9%) than women with a late or unspecified diagnosis. Costs after birth were lower for those with early compared to late diagnosis, with monthly costs of $514 for the mother and $340 for the infants, compared to $705 for the mother and $564 for the infants of mothers with a late diagnosis.

Conclusions:

Many pregnant women with an SUD could be diagnosed and treated earlier. There is an urgent need for early SUD screening and treatment to be integrated in routine maternity care.

Implications for Policy or Practice:

Findings suggest a need for developing and expanding a maternity care workforce trained in SUD screening and treatment, infrastructure investments such as co-location of SUD treatment and prenatal care providers, and development of new integrated care models with early maternal SUD identification and treatment across multiple settings, including pediatric care.