DOES PRENATAL WIC PARTICIPATION IMPROVE CHILD OUTCOMES?

A large body of literature documents positive effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on birth outcomes, and separately connects health at birth and future outcomes. But little research investigates the link between prenatal WIC participation and childhood outcomes. We explore this question using a unique data set from South Carolina that links administrative birth, Medicaid, and education records. We find that relative to their siblings, prenatal WIC participants have a lower incidence of ADHD (attention-deficit/hyperactivity disorder) and other common childhood mental health conditions and a lower incidence of grade repetition. These findings demonstrate that a "WIC start" results in persistent improvements in child outcomes across a range of domains.

Exploding asthma and ADHD caseloads: The role of medicaid managed care.

In the U.S., nearly 11% of school-age children have been diagnosed with ADHD, and approximately 10% of children suffer from asthma. In the last decade, the number of children diagnosed with these conditions has inexplicably been on the rise. This increase has been concentrated in the Medicaid caseload nationwide. One of the most striking changes in Medicaid has been the transition from fee-for-service (FFS) reimbursement to Medicaid managed care (MMC), which had taken place in 80% of states by 2016. Using Medicaid claims from South Carolina, we show that this change contributed to the increase in asthma and ADHD caseloads. Empirically, we rely on variation in MMC enrollment due to a change in the "default" Medicaid plan from FFS to MMC, and on rich panel data that allow us to follow the same children before and after they were required to switch. We find that the transition from FFS to MMC explains about a third of the rise in the number of Medicaid children being treated for ADHD and asthma, along with increases in treatment for many other conditions. These are likely to be due to the incentives created by the risk adjustment and quality control systems in MMC.

The Impact of WIC on Infant Immunizations and Health Care Utilization.

OBJECTIVE: To test how prenatal participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) impacts health care utilization and immunizations within the first year of an infant's life. DATA SOURCE: We utilize comprehensive South Carolina Medicaid claims data from 2004 to 2013 linked with birth certificates data from 2004 to 2012. These data contain information on WIC participation and all health care utilization within the first year of an infant's life. STUDY DESIGN: We employ a maternal fixed-effects empirical design to control for unobserved factors that influence WIC participation and health care utilization. PRINCIPAL FINDINGS: We estimate that WIC participation increases infant health care utilization within the first year of life by 0.20 well-child visits (95 percent CI 0.16-0.23), by 0.22 vaccinations (95 percent CI 0.17-0.27), and by increasing the probability of receiving care in an emergency room by 2.9 percentage points (95 percent CI 2.0-3.8). Additionally, our results show that WIC participation decreases the average number of days an infant spends in the hospital within his or her first year of life by 0.41 days (95 percent CI 0.22-0.60). CONCLUSIONS: These findings suggest that WIC may increase health care costs in some dimensions while reducing it in others, and more work is needed to fully evaluate the impact of the program on future expenditures.

The Impact of WIC on Birth Outcomes: New Evidence from South Carolina.

Objectives To investigate the impact of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) on a variety of infant health outcomes using recent South Carolina Vital Statistics data (2004-2012). Methods To account for non-random WIC participation, the study relies on a maternal fixed effects estimation, due to the availability of unique maternally linked data. Results The results indicate that WIC participation is associated with an increase in birth weight and length of gestation, decrease in the probability of low birth weight, prematurity, and Neonatal Intensive Care Unit admission. Additionally, addressing gestational bias and accounting for the length of gestation, WIC participation is associated with a decrease in the probability of delivering a low weight infant and a small for gestational age infant among black mothers. Conclusions for Practice Accounting for non-random program participation, the study documents a large improvement in birth outcomes among infants of WIC participating mothers. Even in the context of somewhat restrictive gestation-adjusted specification, the positive impact of WIC remains within the subsample of black mothers.

Medicaid reimbursement, prenatal care and infant health.

This paper evaluates the impact of state-level Medicaid reimbursement rates for obstetric care on prenatal care utilization across demographic groups. It also uses these rates as an instrumental variable to assess the importance of prenatal care on birth weight. The analysis is conducted using a unique dataset of Medicaid reimbursement rates and 2001-2010 Vital Statistics Natality data. Conditional on county fixed effects, the study finds a modest, but statistically significant positive relationship between Medicaid reimbursement rates and the number of prenatal visits obtained by pregnant women. Additionally, higher rates are associated with an increase in the probability of obtaining adequate care, as well as a reduction in the incidence of going without any prenatal care. However, the effect of an additional prenatal visit on birth weight is virtually zero for black disadvantaged mothers, while an additional visit yields a substantial increase in birth weight of over 20 g for white disadvantaged mothers.