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294: Medicaid payment policy effects on cesarean birth differ by race

      Objective

      To investigate whether a blended payment rate policy for uncomplicated births (cesarean or vaginal) may affect cesarean use differentially for white and nonwhite Medicaid beneficiaries.

      Study Design

      We identified singleton births to women enrolled in fee-for-service Medicaid, 2006-2012 (N=1,691,988) using Medicaid Analytic eXtract enrollment and claims from 2006-2012 for the policy state (Minnesota) and control states (California, Idaho, Illinois, Iowa, Montana, Oregon, and Wisconsin). Individual-level quarterly interrupted time series analysis was used to assess the changes in level and trend of cesarean use post-policy vs. pre-, comparing Minnesota to control states separately among white and nonwhite (black, Hispanic, and other race) women.

      Results

      Baseline cesarean rates for nonwhite women in policy and control states were 23.64 and 31.46 respectively, and for white women were 22.36 and 28.66. After policy implementation, nonwhite women experienced a 0.44 percentage point decline in the quarterly trend in cesarean rates, relative to nonwhite women in control states (p=0.013). By three years post-policy, this reduction amounted to a 5.28 percentage point relative decrease in cesarean rate compared with control states. There was no level change in cesarean rate at the policy transition point for nonwhite women, and for white women, there were no changes in level or trend.