MED 146 Deliverable 1.24 Five Year Florida Medicaid Maternal and Child Health Status Indicators Report:

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2 MED 1 Deliverable 1. Five Year Florida Maternal and Child Health Indicators Report: -1 Presented to the Florida Agency for Health Care Administration Prepared by the University of Florida Family Data Center Acknowledgements Final June, 1 Staff of the Performance, Evaluation and Research Unit, Florida Agency for Health Care Administration Staff at the Florida Department of Health Staff at the Florida Department of Children and Families Staff at the Family Data Center

3 Florida Maternal & Child Health Indicators -1 Birth Cohorts Table of Contents Executive Summary... 1 Overview... Introduction... Summary of Statewide Trends... Changes in this Year s Report... 1 Structure of the Indicator Tables... 1 Indicators... 1 INDICATOR 1: Deliveries in Florida... 1 INDICATOR : Cesarean Deliveries in Florida... INDICATOR : Deliveries to Women with Inadequate Prenatal Care in Florida... INDICATOR : Mothers who Participated in the Family Planning Waiver Program in Florida... INDICATOR : Pre-term Deliveries in Florida... INDICATOR : Deliveries to Women with First Trimester Entry into Prenatal Care in Florida... INDICATOR : Deliveries to Women Who Reported Smoking during Pregnancy in Florida... INDICATOR : Deliveries to Women with Obese Prepregnancy Body Mass Index (BMI) in Florida... INDICATOR : Deliveries to Women with Underweight Prepregnancy Body Mass Index (BMI) in Florida... INDICATOR 1: Deliveries to Women with Overweight Prepregnancy Body Mass Index (BMI) in Florida... INDICATOR : Deliveries to Adolescents (Age up to 1 Years) in Florida... Family Data Center College of Medicine University of Florida June 1

4 Florida Maternal & Child Health Indicators -1 Birth Cohorts INDICATOR 1: Vaginal Deliveries without Physical Complications in Florida... INDICATOR 1: Vaginal Deliveries with Physical Complications in Florida... INDICATOR 1: Deliveries to Women Participating in Women, Infants, and Children (WIC) Nutrition Program in Florida... INDICATOR 1: Mothers Diagnosed with a Mental Health Condition in Florida....1 INDICATOR 1: Mothers who Plan to Breastfeed in Florida... INDICATOR 1: Deliveries to Pregnant Women Screened by Healthy Start in Florida... INDICATOR 1: Deliveries to Pregnant Women Screened at Increased Risk by Healthy Start in Florida... 1 INDICATOR 1: Deliveries to Women with Interpregnancy Interval (IPI) Less Than 1 Months in Florida... 1 INDICATOR : Women who Died within a Year of Giving Birth... 1 INDICATOR 1: Maternal Deaths... INDICATOR : Births in Florida... 1 INDICATOR : Infants who required Neonatal Intensive Care... 1 INDICATOR : Infant Mortality in Florida... INDICATOR : Births for Infants Screened for Health and Developmental Risk in Florida... 1 INDICATOR : Infants Diagnosed with a Developmental Delay or Disability... 1 INDICATOR : Infants with Verified Maltreatment... 1 INDICATOR : Infants Diagnosed with Birth Anomalies... 1 INDICATOR : Infants Placed in Foster Care... Family Data Center College of Medicine University of Florida June 1

5 Florida Maternal & Child Health Indicators -1 Birth Cohorts INDICATOR : Infants Diagnosed with a Mental Health Condition or Mental Retardation Diagnosis... 1 INDICATOR 1: Births for Infants Screened at Increased Risk for Health and Developmental Problems in Florida.1 INDICATOR : Infant Readmitted to Hospital after Birth... 1 INDICATOR : Pre-term Births with Low Birth Weight in Florida... INDICATOR : Term Births with Low Birth Weight in Florida... INDICATOR : Post-Neonatal Mortality in Florida... 1 INDICATOR : Neonatal Mortality in Florida... INDICATOR : Births with Low Birth Weight in Florida... INDICATOR : Births with Very Low Birth Weight in Florida... Appendices... 1 Appendix 1: Methodology... Data Sources... Assignment Plan... Beneficiaries Assigned to Assignment Plan Types... Data Suppression... Appendix : Definitions of Individual Maternal and Child Health Indicators... Appendix : Definitions of Maternal and Child Health Financial Benchmarks... Appendix : Sources for Relevant U.S. ages on Key Maternal and Infant Indicators... Appendix : Family of Diagnostic Codes Related to Mental Health... Appendix : Listing of Diagnostic Codes Related to Major and Minor Birth Anomalies... 1 Family Data Center College of Medicine University of Florida June 1

6 Florida Maternal & Child Health Indicators -1 Birth Cohorts Appendix : Supplemental Report Comparing and Pre- Assignment Plan Categories within Health Indicators... Family Data Center College of Medicine University of Florida June 1

7 Florida Maternal & Child Health Indicators -1 Birth Cohorts EXECUTIVE SURY Health status indicators are measures that reflect a broad range of factors such as personal behavior, environmental influences, and social conditions, which together provide a snapshot of the health of specific populations. The Florida Maternal and Child Health Indicators Report (HSI) -1 provides information on health indicators related to pregnant women and infants. This executive summary highlights key findings about women and children statewide and those served by. Eight U.S. Healthy People Maternal and Child Health indicator target rates are provided in the table below to provide a basis for comparing Florida s current statewide and rates with U.S. national objectives. None of the differences in and statewide rates for any indicator were tested to determine whether they were statistically significant. Indicator numbers are noted in brackets [ ] next to the indicator name. Comparison between 1 Statewide and Indicator s and Healthy People Target s Four out of eight indicators presented in the table below (Pre-term Deliveries [], First Trimester Entry into Pre-Natal Care (PNC) [], Women Who Plan to Breastfeed [1], and Neonatal Mortality []) had more favorable statewide rates in 1 compared to the U.S. Healthy people Target s. A plus (+) symbol was used to highlight these indicators. The rate of Cesarean Deliveries [] was more favorable in 1 for recipients than the statewide rate (% vs..%). A star (*) symbol was used to highlight this indicator. Indicator [#] Statewide s s U.S Healthy People - Target s 1 Pre-term Deliveries [] 1.% +.%.% First Trimester Entry into PNC [].% +.%.% Cesarean Deliveries [].%.%*.% Low Birth Weight [].%.%.% Very Low Birth Weight [] 1.% 1.% 1.% Women Who Plan to Breastfeed [1].% + 1.% 1.% Infant Mortality []. per 1,.1 per 1,. per 1, Neonatal Mortality []. per 1, +. per 1,.1 per 1, + The Statewide rate for a given indicator is more favorable than the U.S. Healthy people target rate * The rate for the population is more favorable for a given indicator than the statewide rate Note: rates that are not listed using a star (*) symbol are worse for a given indicator than the statewide rate. s that are not listed using a plus (+) symbol are worse for a given indicator than the Healthy People target rate 1 U.S. Healthy People Maternal, Infant, and Child Health Objectives is generated every 1 years by the U.S. Department of Health and Human Services. of low-risk females with no prior cesarean deliveries. This indicator is different in that it measures the percent of infants who are ever breastfed retrospectively as compared to prospectively. Family Data Center College of Medicine University of Florida June 1 1

8 Florida Maternal & Child Health Indicators -1 Birth Cohorts EXECUTIVE SURY (continued) U.S. rates on other key maternal and infant indicators in this report have been derived from the most recent federal and nongovernmental organization publications. These rates are included in the table below on the right and provide a comparison between Florida s statewide or population and current national rates. None of the differences between the statewide or percentages to U.S. percentages on these key maternal and infant indicators were tested to determine whether they were statistically significant. Indicator numbers are noted in brackets [ ] next to the indicator name. Comparison between other key 1 Statewide and Indicator s and National s Four out of five indicators presented in the table below (Deliveries to Adolescents [], Women who had an interpregnancy interval less than 1 months [1], Infants reported with a verified maltreatment [], and Infants receiving early intervention services under IDEA, Part C []) had more favorable statewide rates in 1 than the National rates. A plus (+) symbol was used to highlight these indicators. The rates for infants receiving early intervention services under IDEA, Part C [] were more favorable for recipients than the statewide rate (1.% vs 1.%). A star (*) symbol was used to highlight this indicator. Two indicators, Women who had an interpregnancy interval less than 1 months [1] and Infants receiving early intervention services under IDEA, Part C [] show rates that are more favorable for recipients compared to the national rate. A plus (+) symbol was used to highlight these indicators. Indicator [#] Statewide s s National s Deliveries to Adolescents [].1% +.%.% or. per 1, Women who had an interpregnancy interval less than 1 months [1].% +.%,+ 1.1% [ 1] Infants who required Neonatal Intensive Care [].% 1.%.% or per 1, [] Infants reported with a verified maltreatment [].% +.%.% [FY 1] Infants receiving early intervention services under IDEA, Part C [] 1.% + 1.%* + 1.1% [FFY 1] + The Statewide rate or the rate for a given indicator is more favorable than the national rate * The rate for the population is more favorable for a given indicator than the statewide rate Note: rates that are not listed using a star (*) symbol are worse for a given indicator than the statewide rate. s that are not listed using a plus (+) symbol are worse for a given indicator than the national rate Denominator excludes first time mothers. The percentage includes children with disposition of substantiated or indicated victims. Family Data Center College of Medicine University of Florida June 1

9 Florida Maternal & Child Health Indicators -1 Birth Cohorts Key findings Findings related to existing and new trends, improved outcomes, and health disparities in maternal and child outcomes are summarized below. The number within the bracket denotes the Indicator number associated with each finding in 1: There were over, more and non- deliveries statewide than in 1. [1] out of 1 deliveries were to women who were enrolled in. [1] out of 1 deliveries were through providers. [1] Nearly out of 1 women statewide received adequate prenatal care (i.e., entering prenatal care in the first trimester). [] Smoking rates decreased among pregnant women statewide (.% in 1 to.% in 1). [] 1 out of beneficiaries (.%) had an interpregnancy interval less than 1 months. [1] Despite improved maternal and child health outcomes, there are important disparities among women enrolled in when compared with women not enrolled in, as well as ethnic and racial disparities. Nearly out of 1 Caucasian women enrolled in reported smoking during pregnancy (1.%; compared to.% of Caucasian women not enrolled in in 1). [] A greater number of women enrolled in (.%) were obese prior to pregnancy (compared with 1.% of Non- women). [] The percent of deliveries to adolescents (younger than 1 years) was seven times higher in the population compared to the Non- population (.% vs..%). [] A lower number of women enrolled in planned to breastfeed (1.% compared with.% of Non- women). [1] The low birth weight rate for women covered by remains almost three percentage points higher than that of Non- women (.% vs..% in 1). [] In addition, there are important trends that require attention, particularly related to disparities in receiving adequate prenatal care, rates of obesity prior to pregnancy, and increased number of infants requiring neonatal intensive care. There was an increase in the number of women enrolled in who did not receive adequate prenatal care (from 1.% in to 1.% in 1, although slightly lower than the rate of 1.% in 1). [] Women enrolled in consistently report double the rates of inadequate prenatal care (when compared with Non- women; 1.% vs..%, respectively in 1). [] Of enrollees, more than a third of African American women (.%) were obese prior to pregnancy (compared to nearly a quarter of Caucasian women (.%) and Hispanics (.%). [] African American infants covered by required neonatal intensive care at higher rates (1.%) compared to Caucasian (.%) and Hispanic (.%) infants. [] Family Data Center College of Medicine University of Florida June 1

10 Florida Maternal & Child Health Indicators -1 Birth Cohorts OVERVIEW Introduction The Florida Maternal and Child Health Indicators Report is an annual publication produced for the Florida Agency for Health Care Administration by the University of Florida s Family Data Center (FDC). The purpose of the report is to provide descriptive statistics, including five-year trends on health indicators about pregnant women and their infants. The report stratifies these statistics by ( and Non-); Eligibility (Temporarily Eligible within Non-;, Non-, CMS High Risk OB, SSI, < days or No PNC [Prenatal Care]; Ineligible NonCitizen, Medically Needy within ); Race/Ethnicity (Caucasian, African-American, Hispanic, Asian, Native American, Other); Length of Coverage (High Exposure, Low Exposure); and Assignment Plan (Managed Medical Assistance [], Pre-, and Fee-for-Service [] providers). Deliveries is the number of Florida resident women who delivered a live newborn during a calendar year. The total number of births during the delivery is not reflected in the number of deliveries as multiple births are counted as one delivery. delivery, as distinct from birth, is the unit of analysis for all indicators related exclusively to the mother s pregnancy experience. Birth is the unit of analysis for all indicators related to newborn outcomes. For the purposes of this report, beneficiaries are defined as Florida resident females who were enrolled in for at least one day during their pregnancy. includes pregnant women who have a family income less than 1 percent of the Federal Poverty Level (FPL). These women are eligible for only during their pregnancy and for days following the birth of their child. Non- includes pregnant women who are eligible for as children under age 1 (income less than 1 percent of FPL) or as parents/caretakers of a child under 1 or as children age 1- (based on the 1 Aid to Families with Dependent Children (AFDC) income limits). CMS High Risk OB includes women who have a history of difficult deliveries or a current medical condition that could result in a difficult delivery and are patients in the Department of Health's Children s Medical Services (CMS) High Risk Obstetrical Program based in a Regional Perinatal Intensive Care Center (RPICC). SSI (Supplemental Security Income) includes pregnant women who have a diagnosed disability and who meet specified income requirements. Ineligible NonCitizen includes women who are not U.S. citizens and whose delivery (but not prenatal or postnatal care) was funded by. Medically Needy includes women who have complex medical problems that result in major health care expenditures that reduce their income to a level that enables them to qualify for during pregnancy. Less Than Eight Days or No Prenatal Care (PNC) includes two groups of pregnant women: 1) those who were enrolled in for less than eight days during their pregnancy and therefore, cannot be considered to have Pre- is a combination of all Assignment Plans (, HMO, MediPass, PSN) before the Statewide program implementation (August 1, 1). Recipients in Pre- had their longest pregnancy period before August 1, 1. Family Data Center College of Medicine University of Florida June 1

11 Florida Maternal & Child Health Indicators -1 Birth Cohorts received prenatal care funded by (i.e., most of these women were enrolled in just prior to labor and delivery) and ) those whose infant s birth certificate indicated zero prenatal visits. This category is comprised of women who were not assigned to any of the preceding six eligibility subgroups. Non- beneficiaries are subdivided into the following two mutually exclusive categories: Non- includes pregnant women who were not eligible for during their pregnancy and delivery. Temporarily Eligible includes women who were presumptively eligible for and received prenatal care services funded by for thirty or more days, but who were subsequently determined to be financially ineligible for. The Temporarily Eligible category is considered Non- and the women in this category are counted as Non- for all five-trend years. Assignment Plan is comprised of three categories, Pre-Managed Medical Assistance (Pre-),, and Fee-for-Service (). The Pre- category is a combination of all Assignment Plans (, HMO, MediPass, PSN) before the statewide program implementation (August 1, 1). Recipients in the Pre- period had their longest pregnancy period before August 1, 1. plan recipients are identified as mothers who had the longest pregnancy period after the Statewide program implementation date (August 1, 1) and were identified as eligible to receive services during pregnancy from one of the approved managed care plans. The third Assignment Plan category is. includes recipients who had the longest pregnancy period after the Statewide implementation date (August 1, 1), but were not identified under an plan (see Appendix 1- Methodology). This edition of the HSI report includes both the transition year (1) and the year 1 as the first full year of the program statewide. A detailed description of how the Plan Assignment category was constructed is presented in Appendix. In addition, Appendix includes a before-and-after program implementation comparison of outcome rates on a selected group of health status indicators (see Appendix - Supplemental Report Comparing and Pre- Assignment Plan Categories within Health Indicators). Summary of Statewide Trends Introduction. This section highlights noteworthy statewide trends presented in a series of charts and graphs that are derived from the body of the report. Although these highlights do not capture the level of detail that is in the body of the report, they do demonstrate the important role of in providing support for maternal and child health services in Florida. The charts and graphs also illustrate important differences in birth outcomes among subpopulations within the state. Limitations. This report includes a broad range of descriptive statistics that illustrate the impact that has on the provision of prenatal care as well as labor and delivery services for low-income women. These summary statistics do not establish causal relationships between provision of funded services and birth outcomes among specific populations. The five-year trend statistics provide essential information about the health status of women and children in different classifications, different racial/ethnic groups, or served by different types of health care delivery systems. Where rates are substantially different between groups or higher than expected, state and local officials can review this information and initiate inquiries to better understand possible causes that contribute to these differences. Family Data Center College of Medicine University of Florida June 1

12 Florida Maternal & Child Health Indicators -1 Birth Cohorts Deliveries [Indicator 1] In 1,.% of all deliveries in Florida were to women who were enrolled in (1,1 of 1,), slightly up from % of the state total in. women (those eligible for only during pregnancy and days following the birth of their child) have declined as a proportion of the subgroup (from 1.% in to.% in 1). Without the program, these women would not have been able to access prenatal care and receive medical management during delivery and postpartum. Figure 1 graphs the number of deliveries in Florida by status over the last five years. Note that in 1 there were over, more deliveries statewide than in 1. Figure 1 Number of Deliveries in Florida by, -1 K,,, 1, 1, Figure shows the percent distribution of deliveries by three major race/ethnicity groups in Florida between and 1. The distribution of births among the three major race/ethnicity groups has remained virtually the same over the last five years. Hispanic deliveries in (.%) continue to exceed those of Caucasians (.%) and African American (.1%). This predominance of Hispanic deliveries is consistent with the growth of the Hispanic population in Florida and nationwide over the last decade. Figure Distribution of Deliveries by Three Major Race/ Ethnicity Groups in Florida, -1 % % %.%.%.%.%.%.%.%.%.%.% K %.%.%.%.%.1% 1K 1, 1, 1,1, 1,1 % K K,,,1,1,,,1,,,1 1,,1,,, In 1,.% of deliveries were covered through plans and.% by providers. Nearly all beneficiaries (.1%) were enrolled in plans while.% of Non- beneficiaries were in plans. Figure displays the percent distribution of deliveries by Assignment Plan and Eligibility in 1. Figure displays the percent distribution of deliveries by Assignment Plan and Eligibility in 1. Family Data Center College of Medicine University of Florida June 1

13 Florida Maternal & Child Health Indicators -1 Birth Cohorts Figure - Distribution of Deliveries by Assignment Plan and Eligibility in Florida, 1 1% by and Major Eligibility in Florida between and 1. Figure - of Women with Inadequate Prenatal Care by and Major in Florida, - 1 % %.%.1%.%.%.% % 1.% 1.% 1.% 1.% 1.% % % %.%.% 1.%.%.% 1% 1% 1.1% 1.1% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.% 1.%.%.%.%.%.%.% Inadequate Prenatal Care [Indicator ] % Inadequate prenatal care is a measure that begins at fifth month of pregnancy or later, and indicates receipt of fewer than % of the recommended number of prenatal care visits adjusted for gestational age. Women who receive inadequate prenatal care are more likely to deliver premature, growth retarded, or low birth weight infants. During the past five years, the percent of women with inadequate prenatal care in Florida has increased: from 1.% in to 1.% in 1. A disparity exists between and Non- women with regard to adequacy of prenatal care: nearly 1 percentage points separate and Non- women with inadequate prenatal care (1.% vs..%). Figure shows the percent of women with inadequate prenatal care Figure presents the percent of Caucasian, African- American and Hispanic women with Inadequate Prenatal Care by and Major Eligibility in Florida in 1. Within the population, the percent of women with inadequate prenatal care in 1 was consistently higher in the Non- subgroup compared to the subgroup across all three major race/ethnicity categories. Figure also indicates that in 1, African- Americans had the highest percent of inadequate prenatal care (when compared with Caucasian and Hispanic women) across Eligibility s. Family Data Center College of Medicine University of Florida June 1

14 Florida Maternal & Child Health Indicators -1 Birth Cohorts Figure - of Caucasian, African- American and Hispanic Women with Inadequate Prenatal Care by and Major Eligibility in Florida, 1 % % 1% 1% 1% 1% 1% % % % % % has decreased since 1 (.% in 1 to.% in 1). Also in 1, the percentage of Non- beneficiaries entering prenatal care in the first trimester was six percentage points lower than that of beneficiaries (.% compared to.%). Figure presents the percent of women who entered prenatal care in the first trimester by and Major Eligibility during the years -1. Figure - of Women who Entered Prenatal Care in the First Trimester by and Major in Florida, -1 % %.%.%.%.%.% % First Trimester Entry into Prenatal Care [Indicator ] The percent of women statewide entering prenatal care in the first trimester remained the same between 1 and 1 (.% and.% respectively) (see Table A in the body of the report). Figure illustrates the difference between Non- and pregnant women with regard to this indicator; and nearly fourteen percentage points separate these two groups. In 1,.% of Non- women entered prenatal care in the first trimester compared to.% for beneficiaries. Although the rate of entering prenatal care in the first trimester among Non- women is higher when compared with other groups, it is not clear why it % % % %.%.%.%.%.%.%.%.%.%.%.%.%.%.%.%.% 1.% 1.%.%.% Family Data Center College of Medicine University of Florida June 1

15 Florida Maternal & Child Health Indicators -1 Birth Cohorts Smoking During Pregnancy [Indicator ] Smoking during pregnancy is correlated with poor birth outcomes, specifically, fetal growth restriction and extreme prematurity. Over the last five years, smoking has decreased among both Non- and pregnant women. In 1, the rate of smoking in both groups improved, decreasing the statewide percent from.% in 1 to.%. The rate of pregnant women who reported smoking during pregnancy remains more than four times higher than that of Non- women (.% vs. 1.% in 1). Non- women report slightly higher rates of smoking during pregnancy than women (1.% vs..% in 1). Figure shows the percent of deliveries to women who reported smoking during pregnancy by and Major Eligibility during the years -1. Figure of Deliveries to Women Who Reported Smoking during Pregnancy by and Major Eligibility in Florida, -1 1% 1% % The difference in rates of smoking during pregnancy was evident among women of different race/ethnicity groups: 1.% of Caucasian women in reported smoking compared to.% of Caucasian women not in in 1 (see Figure ). These percentages, however, need to be interpreted with caution because information for this item on the birth certificate comes exclusively from self-report. Nonetheless, the differences in the percent of women who reported smoking between and Non- are important because of the adverse effects on the developing fetus as a result of exposure to tobacco during pregnancy. Figure of Deliveries to Women Who Reported Smoking during Pregnancy by Race/Ethnicity and in Florida, 1 % 1% 1% 1% 1% 1% % % % % % % % % Family Data Center College of Medicine University of Florida June 1

16 Florida Maternal & Child Health Indicators -1 Birth Cohorts Obese Prepregnancy Body Mass Index [Indicator ] A Prepregnancy Body Mass Index (BMI) equal to or greater than is considered obese. An obese Prepregnancy BMI has been correlated with a number of adverse birth outcomes, including cesarean section, pre-term delivery, pre-eclampsia, and macrosomia (infant birth weight of, grams [about 1 pounds] or more). In 1, the percent of women who were obese prior to pregnancy was more than eight percentage points higher than that of Non- women (.% vs. 1.%) (see Table A in the body of the report). The disparity in BMI is also apparent across race/ethnicity groups. In the 1 population, the percent of African American women who were obese was nearly ten percentage points higher than that of Caucasian women (.% vs..%) and Hispanic women (.%). Figure shows the percent of deliveries to women with an obese Prepregnancy BMI by race/ethnicity and status in 1. Figure of Deliveries to Women with an Obese Prepregnancy BMI by Race/Ethnicity and in Florida, 1 Deliveries to Adolescents [Indicator ] In 1, the percent of deliveries to adolescents (1 to 1 years) was seven times higher in the population compared to the Non- population (.% vs..%). Between and 1, the proportion of deliveries to adolescents declined in both and Non- women (from. % to.% and 1.1% to.%, respectively). The decline was especially larger among women than in Non- women, down two percentage points over the five year period (from.% in to.1% in 1) (see Table A in the body of the report). Figure 1 shows the proportion of deliveries to adolescents in the and Non- population as well as within the major Eligibility s over the last five years, -1. Note that the percent of deliveries to adolescents is not equivalent to either the teen pregnancy or teen fertility rates. of deliveries to adolescents will always be affected by the number of deliveries to non-adolescents. Figure 1- Deliveries to Adolescents by and Major Eligiblity in Florida, -1 % % % % 1% 1% % % 1% % % % % % Family Data Center College of Medicine University of Florida June 1 1

17 Florida Maternal & Child Health Indicators -1 Birth Cohorts WIC Participation [Indicator 1] Participation in the Women, Infant and Child Nutrition Program (WIC) has been shown to be associated with positive birth outcomes, including greater likelihood of receiving prenatal care, longer pregnancies, fewer premature births and infant deaths, and savings in health care costs during the first year of life. While financial eligibility for the program is identical to s (up to 1% of the federal poverty level), nearly % of women (, of 1,1 deliveries) in Florida did not enroll in WIC in 1. The rate is 1. percentage points lower than it was in 1. It is possible that pregnant women may not qualify for WIC because they also must be determined to be at nutrition risk, in addition to being financially eligible. WIC enrolled 1, fewer women in 1 than in 1 (and 1, less overall statewide in 1 (see Table 1A in the body of the report). In 1, 1, Non- women participated in WIC (a decrease from 1, in ). This group represents a potential pool of low-income women who may or may not qualify for, depending on whether they have some other form of health insurance. Figure displays the percent of women who delivered and who participated in the WIC Program in Florida from to 1. Figure of Women who delivered and who Participated in the WIC Program in Florida, -1 % % % % % % % % 1% %.%.%.%.1%.% Deliveries to Women Planning to Breastfeed [Indicator 1] Breastfeeding is associated with improved infant health outcomes such as decreased incidence and severity of a wide range of diseases (asthma, respiratory infection, Type diabetes), lower rates of obesity, and fewer problems in motor and intellectual development. In 1, the percent of women who planned to breastfeed was higher among Non- than women (.% vs. 1.%) (see Table 1A in the body of the report). Figure 1 below shows the percent of women who plan to breastfeed by race/ethnicity and status in 1. In the population, for example, the percent of women who planned to breastfeed in 1 was greater among Hispanics (.%) compared to Caucasian and African-American women (.% and 1.%, respectively) (also see Table 1B in the body of the report). Family Data Center College of Medicine University of Florida June 1

18 Florida Maternal & Child Health Indicators -1 Birth Cohorts Figure 1 of Deliveries to Mothers who Plan to Breastfeed by Race/Ethnicity and in Florida, 1 Figure 1 of Interpregnancy Interval Less Than 1 Months for Non- and, and Non- in Florida, -1 1% % % % % % % % % 1% % % % % % 1% 1% % % Interpregnancy Interval Less Than 1 Months [Indicator 1] An interpregnancy interval of less than 1 months has been found to be associated with adverse birth outcomes such as neonatal death and premature infants small for gestational age. In 1,.% of beneficiaries in Florida had an interpregnancy interval less than 1 months. This rate has been declining steadily since when it was.%. More than % of women in three Eligibility s (Non-, SSI, and less than days or No Prenatal Care) had an interpregnancy interval of less than 1 months in 1 (see Table 1A in the body of the report). Figure 1 shows the percent of interpregnancy interval less than 1 months by and Major Eligibility s for the years -1. Infants who Required Neonatal Intensive Care in Florida [Indicator ] During the past five years, the percent of infants who required neonatal intensive care has remained consistent from.% in to.% in 1 (see Table A in the body of the report). There was a slight increase in the subgroup of infants who required neonatal intensive care from 1 (1,) to 1 (1,), (see Figure 1). In 1, among subgroups, 1.% of African American infants required neonatal intensive care compared to.% of Caucasian and.% of Hispanic infants (see Figure 1). Family Data Center College of Medicine University of Florida June 1 1

19 Florida Maternal & Child Health Indicators -1 Birth Cohorts Figure 1 Number of Infants who Required Neonatal Intensive Care in Florida by, -1,, 1,,1 1,,1 1, 1, 1,1,1 1, 1, 1, Infant Mortality [Indicator ] Infant mortality rates are frequently viewed as a measure of the overall health of a community, state, and country. The United States continues to have one of the highest infant mortality rates among developed nations. However, from to 1, the U.S. infant mortality rate declined from. per thousand to. per thousand. Florida s infant mortality rate also declined, from. per thousand in to. per thousand in 1 (see Figure 1). 1,,,1,,,,,,,1,,,1,,,, Figure 1 illustrates the infant mortality rates per 1, from 1-1 by status and major Eligibility. Figure 1 Infant Mortality s per 1, by and Major in Florida, 1-1 Birth Years Figure 1 of Infants who Required Neonatal Intensive Care by Race/Ethnicity, and Major Eligibility in Florida, 1 1% 1% 1% 1% % % % % % % % % % % % % % % % %.%.%.%.1%.%.%.1%.%.%.%.%.%.%.%.%.%.%.%.%.%.%.%.%.%.% Family Data Center College of Medicine University of Florida June 1 1

20 Florida Maternal & Child Health Indicators -1 Birth Cohorts African-American infant mortality rates are consistently higher than those of Caucasians or Hispanics in both the and Non- populations. Among women in 1, the African-American infant mortality rate per 1, live births was more than double that of Hispanics (.1 vs..). Figure 1 shows infant mortality rates in 1 for Caucasians, African-Americans, and Hispanics by and Major Eligibility ( and Non-) Figure 1 Infant Mortality s per 1, for Caucasians, African-Americans, and Hispanics by and Major in Florida, 1 Birth Year 1 1 lower the low birth weight rate in Florida. Between and 1, it declined slightly from.% to.% (see Table A in the body of the report). Figure 1 shows statewide five-year trends in low birth weight rates by and Major Eligibility. The gap separating low birth weight rate in and Non- women has not narrowed over the last five years. The low birth weight rate for women remains almost three percentage points higher than that of Non- women (.% vs..% in 1). There is also considerable variation in low birth weight rates within subgroups. women consistently exhibit a lower low birth weight rate than that of Non- (e.g.,.% vs. 1.% in 1). Figure 1 of Low Birth Weight Newborns by and Major in Florida, -1 1% 1% % % % % % Low Birth Weight [Indicator ] Low birth weight (defined as an infant who weighs less than grams or. pounds at birth) is one of the leading risk factors associated with adverse birth, infant, and child development outcomes, including increased risk for child maltreatment in the first year of life. Numerous state and federal public health initiatives, such as Healthy Start, have begun to Family Data Center College of Medicine University of Florida June 1 1

21 Florida Maternal & Child Health Indicators -1 Birth Cohorts African-American women historically exhibit the highest rates of deliveries of newborns with low birth weight. In 1, the low birth weight rate for African-American beneficiaries was 1.% compared to.% for Caucasians and.% for Hispanics (see Table B in the body of the report). Figure 1 shows the differences in low birth weight rates by race/ethnicity, and Major Eligibility ( and Non-) for the year 1. Figure 1 of Low Birth Weight Newborns by Race/Ethnicity, and Major in Florida, 1 1% 1% % % % Financial Benchmarks [Hospitalization vs. Reimbursement] Looking at deliveries statewide [Indicator 1], one can discern differences in hospitalization charges vs. reimbursement for women and infants (Tables IE IH). The mean maternal delivery inpatient hospitalization charge for women in 1 was $.K (see Table 1E); whereas the mean maternal hospital claims reimbursement for deliveries in 1 was $.K (see Table 1G). This difference represents a reimbursement of approximately 1% for delivery charges. The mean infant birth inpatient hospitalization charges in 1 for beneficiaries was $1.K (see Table 1F), whereas the mean infant hospital (birth) claims reimbursement was $.K (see Table 1H). This difference represents a reimbursement of % for infant birth inpatient hospitalization charges. Similar tables contrasting the mean maternal and infant hospitalization charges with reimbursement of allowable charges to appear at the end of each of the indicators. % % Family Data Center College of Medicine University of Florida June 1 1

22 Florida Maternal & Child Health Indicators -1 Birth Cohorts Changes in this Year s Report On August 1, 1, the Agency completed a statewide rollout of the Managed Medical Assistance () program. recipients who qualified were enrolled in plans and received health care services from one of the approved managed care plans in their area. The previous report (1 edition) grouped Assignment Plan data (Table C across all indicators) using HMO, MediPass, PSN, and categories, consistent with previous editions of the report. For this edition of the HSI report however, because of the fact that more than % of the women who delivered during calendar year 1 received services under the program, the grouping methodology was changed so that the report captures both the transition (1) and the first year post statewide implementation (1). In an effort to provide State officials with descriptive statistics associated with health status indicators before and after the statewide program implementation, this report groups Recipients into three groups: Pre- Managed Medical Assistance (),, and Fee-for-Service () (see Appendix 1- Methodology). A detailed description of how the Plan Assignment category was constructed is presented in Appendix. Appendix also includes a before-and-after program implementation comparison of outcome rates on a selected group of health status indicators (see Appendix - Supplemental Report Comparing and Pre- Assignment Plan Categories within Health Indicators). The changes in the Assignment Plan data led to the following changes in the current 1 report: Table C, which includes assignment plan and length of coverage, presents three assignment plan groups (Pre-,, and ) for the 1 and 1 birth cohorts. Table D, which includes HMO plans, presents two separate tables: 1) HMO plan data showing -1 deliveries, and ) plan data for 1 and 1 deliveries. Furthermore, on October 1, 1, the US implemented the ICD 1-CM (International Classification of Diseases -1th Revision-Clinical Modification), which is much larger and extensive than ICD. The three indicators in the HSI report that rely on ICD codes are: Indicators 1 (Mothers Diagnosed with a Mental Health Condition), (Infants Diagnosed with Birth Anomalies) and (Infants Diagnosed with a Mental Health Condition or a Mental Retardation Diagnosis). The current 1 report presents statistics on mental health and birth anomalies for 1 deliveries that were observed up through the child s first year of life (1). Since the ICD codes before and after October 1, 1 are not comparable, the last quarter data of 1 (October to December 1) for these three indicators is not currently included in the report. Therefore, ICD codes on mental health and birth anomalies are presented in the appendix section of the report. In addition, the current report does not include estimates for Indicator 1 (Maternal Death) since the number of maternal deaths is very low and stratified results show empty tables due to data suppression. Pre- is a combination of all Assignment Plans (, HMO, MediPass, PSN) before the Statewide program implementation (August 1, 1). Recipients in Pre- had their longest pregnancy period before August 1, 1. Family Data Center College of Medicine University of Florida June 1 1

23 Florida Maternal & Child Health Indicators -1 Birth Cohorts Structure of the Indicator Tables The body of this report provides detailed descriptive statistics on indicators focused on pregnancy and birth outcomes for women in Florida who received prenatal services from both and Non- providers. A common series of tables and figures are provided for each indicator. A tables provide the number and percent distribution, or rate of the indicator by classification and by trend year. Each A table is followed by two figures that graph trend lines for the indicator. Note that Indicators 1 (Deliveries) and (Births) have no percent calculation in the A tables since they are their own denominators. Instead, these two indicators begin with a table showing the percent distribution of vs. Non-, as well as the percent distribution of s within for each trend year. All B tables display the race/ethnicity component of the total population who exhibit the Indicator presented in the A tables. The A tables use as their denominator the total number of deliveries reported for each race/ethnic subgroup reported in Indicator Table 1B. For example, Table 1B reports that there were,1 deliveries to Caucasians in 1. Table B reports that there were, Cesarean Deliveries among all Caucasian deliveries, a Cesarean delivery rate for Caucasians of.% in 1 (, divided by,1). This same procedure is used to display the number and percent of each race/ethnicity subgroup for each Indicator (Table B). Table B rates are always based on the total annual population for each subgroup reported in the preceding Table A of a given Indicator. C tables provide the number and percent distribution of the indicator by Assignment Plan (Pre-,, and ) and length of time women were enrolled in a Assignment Plan during pregnancy. High Exposure includes women who had coverage in for 1 days or more during pregnancy. Low Exposure includes women who had coverage in for less than 1 days during pregnancy. Data for only the two latest available birth cohorts are presented for C tables. D tables present two separate tables, D1 and D. D1 tables provide the number and percent distribution of the indicator between and 1 for women who were enrolled in the HMO for greater than 1 days or for at least / of their pregnancy. D tables provide the number and percent distribution of the indicator for 1 and 1 for women who were enrolled in the program. Exceptions to this -year span are tables 1D, 1D, D, D, D and D. They report the number and percent distribution of indicator statistics for the preceding five available years, 1 to 1. There is no Table 1D because the number of deliveries each year is given in the All column of each subsequent indicator, making it unnecessary to include this information in Indicator 1: Deliveries in Florida. Likewise, there is no Table D because the number of births each year is given in the All column of each subsequent indicator, making it unnecessary to include this information in Indicator : Births in Florida. E and F tables supply mean inpatient hospitalization charges and length of stay for mother (delivery) and infant (birth) for each indicator. To answer questions about the financial impact of a certain health condition, these tables Pre- is a combination of all Assignment Plans (, HMO, MediPass, PSN) before the Statewide program implementation (August 1, 1). Recipients in Pre- had their longest pregnancy period before August 1, 1. Family Data Center College of Medicine University of Florida June 1 1

24 Florida Maternal & Child Health Indicators -1 Birth Cohorts present side by side hospitalization charges and length of stay for both mother and child. G and H tables supply mean Claims Reimbursement for delivery and birth hospitalizations by. The Claims is the average amount that paid for mothers and infants who had the health condition represented by each indicator. These tables report data for five birth cohorts (-1]. Indicators (Infant Mortality), (Neonatal Mortality), and (Post-Neonatal Mortality) report deaths that occurred within the first year of life. These indicator tables report mortality statistics for five birth cohorts (1-1) because final mortality statistics for 1 are compiled by the Florida Department of Health during 1 and do not become available until the end of 1. Similarly, Indicators 1 (Mothers Diagnosed with a Mental Health Condition), (Infants Diagnosed with Birth Anomalies) and (Infants Diagnosed with a Mental Health Condition or a Mental Retardation Diagnosis) also report statistics for 1-1 because the Non- group for these indicators relies on finding the ICD codes for these conditions in the 1 Hospital Discharge dataset. As of May 1, FDC does not yet have the full 1 calendar year Hospital Discharge dataset. Family Data Center College of Medicine University of Florida June 1 1

25 Florida Maternal & Child Health Indicators -1 Birth Cohorts Indicators Family Data Center College of Medicine University of Florida June 1 1

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27 Florida Maternal & Child Health Indicators -1 Birth Cohorts Indicator1:DeliveriesinFlorida Table1A:NumberandDistributionofDeliveriesby/ % Number % Al 1 % Number % Al 1 % Number % Al 1 % Number % Al 1 % Number % Al Non-,.% 1.%,.%.%,1.%.%,.%.%,.%.1% Non- TemporarilyEligible*,1.% 1.% 1,1.%.%,1.% 1.1%,.1% 1.%,.% 1.%, 1.%.%, 1.%.%,1 1.%.%,1 1.%.%, 1.%.%, 1.%.%,1.%.%,.%.%,.%.%,1.%.% Non- 1, 1.%.%,1.% 1.%, 1.%.%,.% 1.%,1.% 1.%,1.1%.1%,.%.1%,.%.%,.%.%,.%.% SSI 1,.% 1.%.% 1.1%,1.%.%.% 1.% 1 1,.% 1.%.%.%,1.%.%.% 1.%,.%.1%.% 1.% 1,.%.% 1, 1.%.% 1,.%.% 1,.%.% 1,.%.%,.% 1.%,.1% 1.%,1.1% 1.%,.1% 1.%,.% 1.% 1, 1.%.% 1, 1.% 1.% 1,1 1.%.%, 1.% 1.% 1,1 1.%.% Grand, 1.% 1.%, 1.% 1.%, 1.% 1.% 1, 1.% 1.% 1, 1.% 1.% Notes:*TemporarilyEligiblemeansbeneficiarieswhowerepresumptivelyeligiblebutlaterdeterminedtobefinancialyineligible. % Figure1A(a):DistributionofDeliveries by Non- Year % Figure1A(b):DistributionofDeliveriesbybyYearofDelivery Non- CMSHighRisk OB SSI Ineligible NonCitizen Mcaid<Days ornopnc % % % % % % % % 1% 1% % % Family Data Center College of Medicine University of Florida June 1 1

28 Florida Maternal & Child Health Indicators -1 Birth Cohorts Abc Indicator1:DeliveriesinFlorida Table1B:NumberandDistributionofRace/Ethnicityin1forDeliveriesper/ Caucasian Number % Race/ Ethnicity African-American Number % Race/ Ethnicity Hispanic Number % Race/ Ethnicity Asian Number % Race/ Ethnicity NativeAmerican Number % Race/ Ethnicity Other Number % Race/ Ethnicity Grand Number % Race/ Ethnicity Non-,.%,.% 1,.%,.% 1.%,.%, 1.% Non- TemporarilyEligible* 1.% 1 1.%,.% 1.%.%, 1.%,.%,.% 1,.1%,.1% 1.1%,.%, 1.%,.% 1,.1%,.% 1, 1.%.1% 1,.%,1 1.% Non-,.%,.%,.% 1.% 1.1% 1 1.%,1 1.% 1, 1.% 1, 1.%,.1% 1.1% 1.%, 1.% SSI 1.1%.% 1 1,1 1.1% 1.% 1.% 1.% 1.%.% 1.% 1.%, 1.% 1.%.%.1% 1,1.%.%.% 1, 1.% 1,.% 1.%.%.% 1.%, 1.%,1.% 1,.1%,.% 1, 1.%.1%,.% 1,1 1.% Grand,1.%, 1.% 1,.%,1.%.1%,1.% 1, 1.% Notes:Resultsaresuppressedfornon-zerocelswherethecasecountisunder.ThenumbersintheGrandcolumncanvaryfrom theirrespective/totalsontable1abecausetheempty celsreflectthedatasuppressionandbecausethistablefurtherstratifiestheindicatorbyrace/ethnicitywithineach/,(seeappendix1-methodology,datasuppression). % Figure1B(a):DistributionofRace/Ethnicityin 1forDeliveriesper Non- Race/Ethnicity Caucasian African-American Hispanic Figure1B(b):DistributionofRace/Ethnicityin1forDeliveriesper Non- CMSHigh RiskOB SSI Ineligible NonCitizen Mcaid< DaysorNo PNC % Asian NativeAmerican Other % % % % % % 1% % % Notes:Resultsaresuppressedfornon-zerocelswherethecase countisunder,(seeappendix1-datasuppression). % Notes:Resultsaresuppressedfornon-zerocelswherethecasecountisunder,(seeAppendix1). Family Data Center College of Medicine University of Florida June 1

29 Indicator1:DeliveriesinFlorida Coverage Assignment Plan 1 Number % LOC 1 Number % LOC Non- 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC High PRE-* Low PRE-* PRE-* 1.%.%.1%.% 1, 1, 1 1, 1.%.%.%, 1,1 1.%.%.%.1% 1,1 1,1 1.%.%.% 1, 1,, 1.%.% 1.%.%, 1 1 1, 1.%.%.%.%,1, 1.% 1.% %.%.%.% 1.%.%.%.%,, 1, 1.%.% 1.%.1% 1, 1, 1 1.%.%.%.% 1,1 1, 1.%.% 1.%.1%,, 1.%.% 1.%.%, 1 1, 1.%.1%.%.%,1, 1.% 1.%.1%.% 1 1.%.%.%.% 1 1.%.%.1%.%,,, 1.%.1%.%.%,1,1 1 1.%.%.%.%, 1, 1.%.% 1.%.%,1,, 1.%.%.% 1.1%,, 1.% 1.% 1.%.%,, 1,1 1.% 1.%.%.% 1.%.%.%.% 1 Table1C:NumberandDistributionofDeliveriesby,DeliverySystem,Lengthof Coverage(LOC),andYearofDelivery Coverage Assignment Plan SSI 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC 1 Number % LOC High PRE-* Low PRE-* PRE-* 1.%.%.%.% 1, 1, 1.%.%.%.%, 1, 1.%.% 1.% 1.% 1.%.%.% 1 1.%.%.%.% %.%.%.% 1 1.% 1.%.1%.% 1, 1 1,1,1 1.%.%.%.%,,,1 1.%.%.% 1 1.% 1.%.%.% 1 1.%.%.%.% 1,, 1.%.%.% 1,,, 1.%.1%.%.%,1, 1.%.%.%.% 1, 1,1 1.%.%.%.% 1,,, 1.%.%.%.1% 1,,,1 1.%.%.%.%,1 1 1, 1.%.%.%.%, 1, 1.%.%.%.% 1,, 1.%.%.% 1,,,1 1.%.%.%.1%,, 1.%.% 1.%.%, 1, 1, 1.%.%.%.%, 1,1, 1, 1.%.%.%.% 1,1 1,, Notes:*Pre-isacombinationofalAssignmentPlans(,HMO,MediPass,PSN)beforetheStatewideprogram implementation(august1,1).recipientsinpre-hadtheirlongestpregnancy periodbeforeaugust1,1. Resultsaresuppressedfornon-zerocelswherethecasecountisunder.Thenumbersintherowscanvaryfrom theirrespectivetotalsontable1abecausetheemptycelsreflect thedatasuppressionandbecausethistablefurtherstratifiestheindicatorbylengthofcoverageanddeliverysystem withineach,(seeappendix1-methodology,datasuppression). Florida Maternal & Child Health Indicators -1 Birth Cohorts Family Data Center College of Medicine University of Florida June 1

30 Indicator1:DeliveriesinFlorida Non- Non- TemporarilyEligible* Non- SSI Grand $1.K $1.K $1.K % $1.K $1.K $1.K % % $1.K $1.K $1.K % % $.K $1.K $.K % $.K $1.K $.K % % % $1.K $1.K $1.K $1.K $1.K $.K $1.K $1.K % % $1.K $1.K $1.K $1.K $1.K $.K $1.K $1.1K % % $.K $.K $1.K $.K $.K $.K $1.K $.K % % $1.K $.K $1.K $.K $.K $1.K $.K $1.K % % % % $.K $.K $.K $.K $.1K $.K $.K $.1K % 1% % % % % $1.K $1.K $.K $1.K $.K Table1E:MaternalDeliveryInpatientHospitalizationandLengthofby/andStatewide Notes:referstotheproportionofaloftheindicator'sdeliveriesthatwerelinkedtotheirdeliveryinpatienthospitalizationdischargerecord Non- Non- TemporarilyEligible* Non- SSI Grand $1.K $.K $1.K % 1% % $1.K $.K $.K % $.K $.K $.K % $1.1K $1.K $1.K % $.K $.K $.K % % $1.K $1.K $.K $1.K $1.K $.K $.1K $1.K % % % % % % % % $1.K $.K $.1K $1.K $1.K $.K $1.K $.K 1 % % % % % % % $1.K $.K $.K $1.K $.K $.K $.K $.K % % % % % % % $1.K $.K $.K $1.K $1.K $1.K $1.K $1.K % % % % $1.K $.K $.K $1.K $.K $.K $1.K $1.1K % % % % 1% $.K % $1.K $1.K $1.K % $1.K Table1F:InfantBirthInpatientHospitalizationandLengthofby/andStatewide Notes:Birthreferstotheproportionofaloftheindicator'sBirthsthatwerelinkedtotheirbirthinpatienthospitalizationdischargerecord. Florida Maternal & Child Health Indicators -1 Birth Cohorts Family Data Center College of Medicine University of Florida June 1