The impact of legislation and secular trends on newborn length of stay for Medicaid infants in Ohio

Objectives: To examine the impact of state legislation mandating minimum maternal and newborn length of stay (LOS). Study design: By using Medicaid claims data linked to vital statistics files, LOS, and "short stay" (less than or equal to1 day after vaginal delivery, less than or equal to 2 days after cesarean delivery) were determined for 151,464 term newborns born to mothers receiving Medicaid in Ohio from July 1, 1991 to June 30, 1998. Changes in LOS and "short stay" were examined for 4 periods that reflected events occurring in Ohio at the time. Results: The proportion of newborns discharged after a "short stay" increased dramatically before legislation (7/1/91-8/31/95) but decreased after the introduction of legislation (9/1/95-6/30/96). In the 4 months after passage of the law, but before its effective date (Period III), the odds of a "short stay" decreased. This decrease continued in the 20 months after the law went into effect (Period IV). White, young, married mothers without a high school degree or with poor prenatal care and lower birth weight infants were more likely to be discharged early. Conclusions: LOS and "short stay" returned to near-1991 levels for Medicaid newborns in Ohio after legislative activity.