Background: Low income patients often require non-medical services in addition to traditional medical services. Historically, these have mostly been available from public providers. In Oregon Health Plan (OHP) required that Medicaid beneficiaries enroll in managed care. Since its implementation, many enrollees have switched their source of care from the public to the private sector, leading to concern that those cared for in the private sector may not be referred as appropriately to programs, such as the Supplemental Food Program for Women. Infants, and Children (WIC), which have been shown to improve birth outcomes for high risk populations. Goals: The overall goal of the proposed research is to evaluate the effect of a mandated change in source of care for low income Oregonians; specifically the change from public to private providers as mandated in Oregon by the OHP in 1994. The specific goals are to compare participation in WIC of Medicaid patients before and after implementation of the OHP, where WIC is used as an indicator of referral to appropriate community programs for high risk populations. Methods: The main hypothesis is that medicaid patients in a managed care environment who seek care from private practitioners in any type of site or managed care plan are less likely to participate in WIC than patients seen by more traditional providers for low income populations, such as public clinics or closed panel HMOs, and hence may be more likely to experience adverse birth outcomes. The study will be conducted by linking birth certificates, WIC utilization records, and medical assistance eligibility and enrollment data to compare the prenatal care experiences of women throughout the state before and after implementation of the OHP. This methodology will allow a comparison of women receiving care in fee for service delivery system with those enrolled in different types of managed care arrangements. Policy Implications: The effects of the OHP, a widely watched experimental reform, are of great interest to policy makers nationally and internationally. In addition, because Oregon has a long history of managed care and more experience with Medicaid managed care than most other states, any effect observed there could reasonably be anticipated wherever a large scale conversion to Medicaid managed care occurs, and thus the research is highly relevant today to a wide range of parties.
