Receipt of guideline-concordant prenatal care among Medicaid-insured women with disabilities in Texas

Objective: To assess receipt of guideline-concordant prenatal care among pregnant women with disabilities enrolled in Medicaid. Methods: We conducted a retrospective cohort study of 748,304 births to women enrolled in Texas Medicaid from 2010-2015. Births were classified into three groups by maternal disability status: no disability, receipt of federal disability benefits (STAR+), or disability identified through ICD-9 codes. Guideline-concordant care was defined as receipt of recommended prenatal services at recommended times. Multivariable logistic regression estimated adjusted odds ratios (aORs) for guideline-concordant care, adjusting for covariates. Results: There were 20,700 births (2.8%) to women with disabilities, 40.1% of whom were enrolled in STAR+. Fewer than half of women in any group received guideline-concordant testing for D(Rh) antigen, rubella, complete blood count, bacteriuria, or glucose tolerance. Women in STAR+ were more likely than those without disabilities to receive no prenatal care (9.4% vs. 1.6%), despite higher first-trimester initiation among those who accessed care. STAR+ enrollment was associated with substantially lower odds of guideline-concordant testing, including HIV (aOR 0.27; 95% CI, 0.26-0.29), syphilis (0.33; 0.31-0.35), hepatitis B (0.38; 0.36-0.40), D(Rh) antigen (0.31; 0.30-0.33), anatomy ultrasound (0.32; 0.31-0.34), and glucose (0.42; 0.40-0.44). Women with disabilities identified via ICD-9 codes also had lower odds, though differences were smaller. Conclusion for practice: Guideline-concordant prenatal care was suboptimal overall and especially deficient among women receiving federal disability benefits, underscoring the need for targeted quality improvement in Medicaid prenatal care delivery.