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Insurance Coverage and Prenatal Care Among Low-Income Pregnant Women: An Assessment of States Adoption of the Unborn Child Option in Medicaid and CHIP

Jarlenski, Marian P. MPH*; Bennett, Wendy L. MD, MPH†,‡; Barry, Colleen L. PhD, MPP*; Bleich, Sara N. PhD*

Medical Care:
doi: 10.1097/MLR.0000000000000020
Original Article
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.

Author Information

*Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine

Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

M.P.J. was supported by the Johns Hopkins Bloomberg School of Public Health June Culley Scholarship in Health Policy and Management.

The authors declare no conflict of interest.

Reprints: Marian P. Jarlenski, MPH, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 405, Baltimore, MD 21205. E-mail: mjarlens@jhsph.edu.

© 2014 by Lippincott Williams & Wilkins.