Start: March 2011

End: March 2014

Funder: Aetna, Inc., the Aetna Foundation, and the Annie E. Casey Foundation


Research suggests that adult Medicaid beneficiaries in select regions, particularly those from racial and ethnic minority groups, disproportionately receive care from small, under-resourced primary care practices. Little is known, however, about the obstetric and pediatric practices that serve Medicaid/CHIP-enrolled women and children, and whether disparities in quality of care exist at these sites. This information is critical to practice-site improvement efforts, given Medicaid’s role as the nation’s largest payer of obstetric services and, together with CHIP, as the health insurer for one-third of all children in the U.S.

CHCS worked with Medicaid agencies in Arkansas, Iowa, and Pennsylvania to explore: (1) what practice settings are serving high volumes of pediatric and obstetric practices enrolled in Medicaid/CHIP, and how that varies by patient race/ethnicity; (2) whether disparities exist in the quality of care among practices of different sizes (i.e., number of providers); and (3) payment disparities between Medicaid/CHIP and Medicare for pediatric and obstetric practices, and how those differences may be associated with quality of care. Findings were published to inform state efforts in health care system redesign and practice-site interventions to improve health quality for Medicaid/CHIP beneficiaries.