Insurance Coverage and Prenatal Care Among Low-Income Pregnant Women

An Assessment of States’ Adoption of the “Unborn Child” Option in Medicaid and CHIP

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.