Insurance coverage and prenatal care among low-income pregnant women: An assessment of states' adoption of the "unborn child" option in medicaid and CHIP

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND:: The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would otherwise have difficulty enrolling in or would be ineligible for Medicaid. OBJECTIVES:: To examine the association of the UC option with the probability of enrollment in Medicaid/CHIP during pregnancy and probability of receiving adequate prenatal care. RESEARCH DESIGN:: We use pooled cross-sectional data from the Pregnancy Risk Assessment Monitoring System from 32 states between 2004 and 2010 (n=81,983). Multivariable regression is employed to examine the association of the UC option with Medicaid/CHIP enrollment during pregnancy among eligible women who were uninsured preconception (n=45,082) and those who had insurance (but not Medicaid) preconception (n=36,901). Multivariable regression is also employed to assess the association between the UC option and receipt of adequate prenatal care, measured by the Adequacy of Prenatal Care Utilization Index. RESULTS:: Residing in a state with the UC option is associated with a greater probability of Medicaid enrollment during pregnancy relative to residing in a state without the policy both among women uninsured preconception (88% vs. 77%, P<0.01) and among women insured (but not in Medicaid) preconception (40% vs. 31%, P<0.01). Residing in a state with the UC option is not significantly associated with receiving adequate prenatal care, among both women with and without insurance preconception. CONCLUSIONS:: The UC option provides states a key way to expand or simplify prenatal insurance coverage, but further policy efforts are needed to ensure that coverage improves access to high-quality prenatal care.

Original languageEnglish (US)
Pages (from-to)10-19
Number of pages10
JournalMedical care
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Medicaid
  • PRAMS
  • insurance
  • prenatal care
  • vulnerable populations

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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