Cilenti studies impact of financial downturn, budget cuts on health services for North Carolina’s women and children

March 3, 2015

A study led by a UNC Gillings School of Global Public Health researcher has examined the impact of North Carolina state budget cuts upon maternal health service use and outcomes among Medicaid-enrolled pregnant women in the state.

Dr. Dorothy Cilenti

Dr. Dorothy Cilenti

Dorothy Cilenti, DrPH, clinical assistant professor of maternal and child health and adjunct professor of health policy and management at the Gillings School, is lead author of the study, published in the February issue of the Journal of Public Health Management and Practice.

Acknowledging that downturns in the economy tend to affect most profoundly those people at the bottom of the economic scale, Cilenti and colleagues determined to analyze how the Great Recession that began in 2008 affected the poorest mothers and their children during 2009 and 2010.

Maternal and child health services historically have been at the center of the health services safety net in the U.S., with infant mortality and morbidity rates reflecting the health of local communities. Pregnancy services originally were mandated by all states’ Medicaid programs, but fiscal pressures related to decreased funding and increased enrollment in the program have caused some to reassess what services can be made available.

In 2009, Medicaid covered more than half of North Carolina’s 126,785 live births. That year, N.C. reduced reimbursement rates for case management services for pregnant women by 19 percent, despite the recession’s disproportionate impact upon the state and its workers.

Many of the health outcomes for women and children remained stable over the course of 2010, but among outcome variables was a decrease in the number of obstetric visits.

The authors suggest that the stable health outcomes may be due to more women enrolling in Medicaid during the recession who only recently had suffered financial setbacks, e.g., job loss, that pushed them into poverty. The stability reflected in the study, they say, also has to do with the short-term nature of the analysis, in that the study did not review longer-term outcomes such as neonatal and infant mortality.

“The need for safety-net services is likely to grow over time,” the authors write, “given that the post-recession recovery disproportionately has benefited those with higher incomes [and that the] Affordable Care Act (ACA) will strain the safety net as millions of previously uninsured…compete with traditional Medicaid participants for outpatient and inpatient care.”

Medicaid remains a critical safety net for pregnant women and their young children, they note:

“With the implementation of the ACA, states have the potential opportunity to better manage high-needs populations, simplify Medicaid eligibility rules, streamline the enrollment process, and thus potentially reduce gaps in the current health care safety net. Trends identified in this study merit continued empirical monitoring and underscore the importance of political will to maintain an adequate safety net for vulnerable women and children.”

Cilenti was invited to present the findings and implications of the study to an AcademyHealth briefing in Washington, D.C., in fall 2014. The briefing focused upon public health services and systems research (PHSSR), specifically about the impact of funding reductions and policy changes on maternal and child health outcomes.

The report on the briefing is available online.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

Recent News