Access to Adequate Prenatal Care and Delivery Services Among Female Youth in Foster Care: Michigan Medicaid Claim Analysis

To observe pregnancy prevalence and service delivery among foster youth and examine impact on prenatal care utilization by a state policy insurance change. This cohort study utilizes linked, state administrative data to analyze child welfare and Medicaid claims of 4721 female foster youth in Michigan. 38.3% had pregnancy-related charges, and 17% experienced at least one birth. Only 64% received adequate prenatal care. Geography (Urban vs rural), and type of health insurance are significant predictors of prenatal care access for youth in foster care with youth in the largest urban county and those enrolled in managed care Medicaid plans receiving less care than youth living in smaller counties and those enrolled in fee for service Medicaid plans. Number of placements and type of placement were not associated with prenatal care access. Pregnancy prevalence in foster youth is much greater than in non-foster youth. Type of insurance model and geographic area a youth resides in significantly affect adequate prenatal care. Although not significant, age and racial disparities were also trending towards significance in terms of prenatal care access. Younger pregnant foster youth and Black youth received less care. Our findings may be indicative of access to adequate prenatal care by foster youth in other states.