Abstract
Medicaid claims are an important, but underutilized source of data for neonatal health services research in the United States. However, identifying live births in Medicaid claims data is challenging due to variation in coding practices by state and year. Methods of identifying live births in Medicaid claims data have not been validated, and it is not known which methods are most appropriate for different research questions. The objective of this study is to describe and validate five approaches to identifying births using Medicaid Analytic eXtract (MAX) from 45 states (2006–2014). We calculated total number of MAX births by state-year using five definitions: (1) any claim within 30 days of birth date listed in personal summary (PS) file, (2) any claim within 7 days of PS birth date, (3) live birth ICD-9 in inpatient or other therapies file, (4) live birth ICD-9 code in inpatient file, (5) live birth ICD-9 in inpatient file with matching PS birth date. We then compared the number of MAX births by state and year to expected counts using outside data sources. Definition 1 identified the most births (14,189,870) and was closest to total expected count (98.3%). Each definition produced over- and underestimates compared to expected counts for given state-years. Findings suggest that the broadest definition of live births (Definition 1) was closest to expected counts, but that the most appropriate definition depends on research question and state-years of interest.
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Data availability
Medicaid Analytic Extract (MAX) Data is available for purchase through the Research Data Assistance Center (ResDAC). Medicaid enrollment data is publicly available from the Centers for Medicare and Medicaid Services (CMS). Original data from the National Center for Health Statistics (NCHS), the Kaiser Family Foundation, and March of Dimes are publicly available and derived state-year estimates from this data are included in supplementary material.
Code availability
SAS code is available from the authors upon request.
References
Anum, E.A., Retchin, S.M., Garland, S.L., Strauss, J.F., III.: Medicaid and preterm births in Virginia: an analysis of recent outcomes. J. Womens Health. 19, 1969–1975 (2010)
Kaiser Family Foundation: Births Financed by Medicaid. https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/ (2016). Accessed 20 July 2020
Byrd, V., Hedley Dodd, A.: Assessing the usability of encounter data for enrollees in comprehensive managed care across MAX 2007–2009. Centers for Medicare and Medicaid Services Policy Brief. https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidDataSourcesGenInfo/Downloads/MAX_IB_15_AssessingUsability.pdf (2012). Accessed 25 May 2021.
Byrd, V.L., Dodd, A.H.: Assessing the usability of MAX 2008 encounter data for comprehensive managed care. Medicare Medicaid Res. Rev. 3, 1 (2013)
Centers for Disease Control and Prevention: Natality - Birth Records (Expanded) Documentation. https://wonder.cdc.gov/wonder/help/Natality-expanded.html (2020). Accessed 25 May 2021.
Centers for Medicare and Medicaid Services: State Summary 2016 TAF DQ Topical Snapshot. https://resdac.umn.edu/taf-data-quality-resources (2016). Accessed 25 May 2021.
Centers for Medicare and Medicaid Services: Data Quality Atlas. https://www.medicaid.gov/dq-atlas/landing/topics/info (2020). Accessed 25 May 2021.
Centers for Medicare and Medicaid Services: Early and Periodic Screening, Diagnostic, and Treatment. https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html (2021). Accessed 25 May 2021.
Dahlen, H.M., McCullough, J.M., Fertig, A.R., Dowd, B.E., Riley, W.J.: Texas medicaid payment reform: fewer early elective deliveries and increased gestational age and birthweight. Health Aff. (millwood) 36, 460–467 (2017). https://doi.org/10.1377/hlthaff.2016.0910
DiMaggio, C., Li, G.: Emergency department visits for traumatic brain injury in a birth cohort of medicaid-insured children. Brain Inj. 27, 1238–1243 (2013). https://doi.org/10.3109/02699052.2013.809552
DiMaggio, C., Sun, L., Li, G.: Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort. Anesth. Analg. 113, 1143–1151 (2011). https://doi.org/10.1213/ANE.0b013e3182147f42
Faherty, L.J., Kranz, A.M., Russell-Fritch, J., Patrick, S.W., Cantor, J., Stein, B.D.: Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome. JAMA Netw. Open. 2, e1914078–e1914078 (2019)
Gourevitch, R.A., Friedman Peahl, A., McConnell, M., Shah, N.: Understanding the impact of prenatal care: improving metrics, data, and evaluation. Health Affairs Blog. (2020). https://doi.org/10.1377/hblog20200221.833522/full/ Accessed 25 May 2021.
Johnson, K., Rosenbaum, S., Handley, M. The next steps to advance maternal and child health in medicaid: filling gaps in postpartum coverage and newborn enrollment. Health Affairs Blog. https://doi.org/10.1377/hblog20191230.967912/full/ (2020). Accessed 25 May 2021.
Johnson, K.: Missing Babies: Best Practices for Ensuring Continuous Enrollment in Medicaid and Access to EPSDT. Johnson Group Consulting, Inc. https://ccf.georgetown.edu/wp-content/uploads/2021/03/missing_babies_EPSDT_Medicaid_finalJan2021_Johnson.pdf. (2021). Accessed 25 May 2021.
Kranz, A.M., Rozier, R.G., Stein, B.D., Dick, A.W.: Do Oral Health Services in Medical Offices Replace Pediatric Dental Visits? J. Dent. Res. 99, 891–897 (2020). https://doi.org/10.1177/0022034520916161
Lorch, S.A., Passarella, M., Zeigler, A.: Challenges to measuring variation in readmission rates of neonatal intensive care patients. Acad. Pediatr. 14, S47–S53 (2014). https://doi.org/10.1016/j.acap.2014.06.010
MacDorman, M., Declercq, E.: Trends and state variations in out-of-hospital births in the United States, 2004–2017. Birth Berkeley Calif. 46, 279–288 (2019). https://doi.org/10.1111/birt.12411
March of Dimes: Peristats, https://www.marchofdimes.org/peristats/Peristats.aspx (2021). Accessed 25 May 2021.
Medicaid and CHIP Payment and Access Commission: Medicaid’s Role in Financing Maternity Care. https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid%E2%80%99s-Role-in-Financing-Maternity-Care.pdf (2020). Accessed 25 May 2021.
Phiri, K., Williams, P.L., Dugan, K.B., Fischer, M.A., Cooper, W.O., Seage, G.R., Hernandez-Diaz, S.: Antiretroviral Therapy Use during Pregnancy and the Risk of Small-for-Gestational-Age Birth in a Medicaid Population. Pediatr. Infect. Dis. J. 34, e169–e175 (2015). https://doi.org/10.1097/INF.0000000000000712
Research Data Assistance Center: MAX Other Therapy File, https://www.resdac.org/cms-data/files/max-ot (2019). Accessed 25 May 2021.
Winkelman, T.N.A., Villapiano, N., Kozhimannil, K.B., Davis, M.M., Patrick, S.W.: Incidence and costs of neonatal abstinence syndrome among infants with medicaid: 2004–2014. Pediatrics 141, 1 (2018). https://doi.org/10.1542/peds.2017-3520
Funding
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R21DA045212 (Faherty). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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All authors contributed to the study design, interpretation of the data, and critical revision of the manuscript. AK acquired the data and SH analyzed the data and drafted the manuscript.
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Heins, S.E., Faherty, L.J. & Kranz, A.M. A comparison of approaches to identify live births using the medicaid analytic extract. Health Serv Outcomes Res Method 22, 49–58 (2022). https://doi.org/10.1007/s10742-021-00252-w
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DOI: https://doi.org/10.1007/s10742-021-00252-w