Maternal and Child Health Journal

, Volume 17, Issue 8, pp 1518-1525

First online:

Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

  • Shun ZhangAffiliated withNational Center for Primary Care at Morehouse School of Medicine Email author 
  • , Kathryn CardarelliAffiliated withDepartment of Epidemiology, University of North Texas Health Science Center
  • , Ruth ShimAffiliated withDepartment of Psychiatry, Morehouse School of Medicine
  • , Jiali YeAffiliated withNational Center for Primary Care at Morehouse School of Medicine
  • , Karla L. BookerAffiliated withDivision of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine
  • , George RustAffiliated withNational Center for Primary Care at Morehouse School of Medicine

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To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.


Disparities Medicaid Economic burden Adverse maternal-child health outcomes and eliminating disparities