Linking Birth and Medicaid Data for MCH Policy and Program Development

1
Linking Birth and Medicaid Data for MCH Policy
and Program Development

• Presentation to
• Association of Maternal and Child Health Programs
• Mary Alice Lee, Ph.D.
• Amanda Learned, B.A.

2
Overview

• Describe methods used to link birth certificate
  data with Medicaid data
• Development and evaluation of data matching
  algorithm
• Interagency collaboration and data sharing
• Illustrate ways in which linked data can be used
  to inform MCH policy and program development

3
Connecticuts HUSKY Program

• HUSKY AMedicaid managed care program
• Children
• Parents/caretaker relatives in families with
  income
• Pregnant women
• Covers 215,000 children and 91,000 adults
  (01/2005)

4
Independent Performance Monitoring in HUSKY A

• Supported by Connecticut General Assembly
• State-funded, with additional funds from private
  foundations for special studies
• Value-added
• Accountability for federal and state dollars
• Accountability for program change
• Information and data sharing for policy
  development, surveillance and health planning
• Data quality assurance

5
Limitations of Existing Data on Births to
Mothers in Medicaid

• CT birth certificate does not have field for
  payer
• HUSKY A health plan reports on prenatal care and
  birth outcomes are not always complete
• HUSKY A health plans report on adequacy of
  prenatal care once the mother is enrolled
• Encounter records for mother and baby
• cannot be readily linked

6
Interagency Collaboration The Bridge

• Worked with staff from state Medicaid and public
  health agencies to develop an algorithm for
  matching CT birth data and HUSKY A enrollment
  data
• Designed study and obtained approval from CT
  Department of Public Health Human Investigations
  Committee for release of birth data
• Worked with agency staff on design of
  interagency data-sharing agreement

7
Data Elements for Linkage

• Mothers Social Security number (SSN)
• Mothers exact first last names (NAME)
• Mothers exact date of birth (DOB)
• Babys date of birth (DOB)
• (to verify that mother was enrolled
  when the baby was born)

8
BIRTH DATA 43,075 births
HUSKY A ENROLLMENT DATA 293,548 ever enrolled 
STEP 1 Match mothers SSN and Verify mothers
enrollment on babys DOB   9,173 records matched
STEP 2 Match mothers NAME and DOB and Verify
mothers enrollment on babys DOB   457 records
matched
 9,630 RECORDS MATCHED
9
Evaluation of Match (1)

• For records with match on SSN
• Did NAME match?
• Did DOB match?
• For records with match on NAME and DOB
• Was SSN missing or different?

10
BIRTH DATA 43,075 births
HUSKY A ENROLLMENT DATA 293,548 ever enrolled 
STEP 1 Match mothers SSN and Verify mothers
enrollment on babys DOB   9,173 records matched
3 did not match on mothers exact DOB
5 did not match on exact mothers first NAME
       10 did not match on exact mothers
last NAME        first or last NAME
STEP 2 Match mothers Exact First Name and Exact
Last Name and Verify mothers enrollment on
babys DOB   457 records matched
-  14 missing SSN on birth certificate -  86
with SSN that did not match
 9,630 RECORDS MATCHED
11
Evaluation of Match (2)

• Two HUSKY A health plans provided mothers SSN
• 97 of records found in linked dataset
• Two HUSKY A health plans provided mothers name
  and maternal date of birth
• 85 of records found in linked dataset

12
Results
13
Extent of HUSKY A Coverage

• By maternal residence
• 60 of births to Hartford mothers
• 52 of births to New Haven mothers
• 44 of births to Bridgeport mothers
• Nearly half births in five other towns
• By race/ethnicity
• 48 of births to African American mothers
• 49 of births to Hispanic mothers

14
How Data Have Been Used to Inform Policy and
Program Development

• To show how publicly funded health program
  contributes to maternal and infant health in CT
• To identify health risks among low income women
  that can be addressed through Medicaid and public
  health programs
• To identify opportunities for increasing
  access to and coordination between
  programs

15
Medicaid Coverage for Smoking Cessation

• Bill raised in state legislature that would
  have made treatment for tobacco dependence a
  covered benefit

16
Subspecialty Care for VLBWT Babies

• Question raised about access to appropriate
  level of care for high risk mothers and newborns
  in Medicaid managed care

17
Impact of Premiums on Pregnant Women in Medicaid

• In 2003, CT proposed charging premiums for
  pregnant women in Medicaid in families with
  income 50 federal poverty level
• Estimated 2,000 low-income pregnant women would
  fail to enroll or lose coverage
• Repealed in 2004

18
Effect of Timely Enrollment on Prenatal Care and
Birth Outcomes

• Question raised by HUSKY A health plans about
  when pregnant women enroll

19
Future Opportunities for Study

• Linked birth-Medicaid data and HUSKY A encounter
  data
• Infant health and health care
• Dental care in pregnancy
• Linked birth-Medicaid data and enrollment data
  from other publicly funded programs
• WIC participation
• Early intervention programs

20
Challenges

• Continuing state funding for independent
  performance monitoring
• Enhancing resources for data management and
  analysis of large datasets
• Complying with HIPAA restrictions on disclosure
  of protected health information
• Evaluating effects of program change
• Improving data quality

21
For more information

• Mary Alice Lee, Ph.D.
• Senior Policy Fellow
• Connecticut Voices for Children
• 60 Gillett Street Suite 204
• Hartford, Connecticut 06105
• 860-548-1661/548-1783 fax
• MALee_at_ctkidslink.org
• www.ctkidslink.org

• Amanda Learned, B.A.
• Systems Analysis Manager
• MAXIMUS, Inc.
• 11419 Sunset Hills Road
• Reston, Virginia 20190
• AmandaLearned_at_MAXIMUS.com