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An Evaluation of North Dakota’s Medicaid Targeted Case Management Program for High-Risk Pregnant Women and Infants The Targeted Case Management (TCM) Program for High-Risk Pregnant Women and Infants has been authorized by the North Dakota Medicaid Program since 1997. Eligible women are those enrolled in the North Dakota Medicaid Program who have risk factors that could result in poor birth outcomes. The goals of the TCM Program are to: • Provide early and continuous prenatal care. • Identify risk factors and develop a plan to lessen the risks. • Connect women to support services that will contribute to a healthy baby. • Improve current and long-term life situations. • Enhance the maternal life course, such as employment and education. • Improve child health by promoting preventive health services, such as immunizations and well-baby checkups. The North Dakota Department of Human Services conducted a retrospective cohort study to evaluate the effectiveness of the TCM Program. The study group was comprised of women who participated in the TCM Program. The control group was comprised of women with similar characteristics who did not receive TCM. The two groups were compared for birth outcomes and selected health problems for both the mothers and their babies. Study Group The study group consisted of women who received TCM and had a delivery paid for by Medicaid during 2001 or 2002. Because TCM services are provided primarily by Healthy Start agencies on either the Turtle Mountain Reservation or the Spirit Lake Reservation, the study group was limited to women who were American Indian and had a county of residence listed on their child’s birth certificate as Benson, Ramsey or Rolette. Sixtysix women met the criteria to be included in the study group. Control Group Other than participation in TCM, the control group had the same inclusion criteria as the study group. The women in the control group had a birth paid by Medicaid during 2001 or 2002, were American Indian and were residents of Benson, Ramsey or Rolette counties. In addition, they had risk factors comparable to women in the study group. Eligibility for TCM is based on an assessment of the presence of risk factors. To be considered high risk, women must meet any one of a list of 11 risk factors or any three of an additional 14 risk factors. To assess similar risk for control group members, risk factors were determined from their child’s birth certificate. Overall, 12 of the total 25 risk factors were found on the birth certificates. In order to be included in the control group, women needed to meet the same criteria as TCM participants based on identified risk factors. Study Design The study was designed to assess three levels of comparison between the study group (TCM) and the control group. They were: TCM Evaluation continued on p. 2