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The State Children's Health Insurance Program (SCHIP) and Prepregnancy Coverage of Teenage Mothers

Adams, E Kathleen PhD*; Gavin, Norma I. PhD; Ayadi, M Femi PhD; Colley-Gilbert, Brenda PhD, MSPH§; Raskind-Hood, Cheryl MS, MPH*

doi: 10.1097/MLR.0b013e31818888de
Original Article

Background: The 1997 State Children's Health Insurance Program (SCHIP) program allowed states to expand Medicaid to uninsured children through age 18 in families under 200% of the federal poverty level. Prepregnancy insurance coverage of adolescents may help reduce unintended pregnancies, address other medical issues, and allow for early and adequate prenatal care for those carrying to term.

Objectives: We tested the effects of SCHIP implementation on insurance coverage for teenage mothers and investigated whether these effects varied by type of state SCHIP program—Medicaid expansion, stand-alone program, or some combination of these.

Research Design: We used Pregnancy Risk Assessment Monitoring System data from 1996 through 2000 and difference-in-differences analysis to analyze coverage changes for teenage mothers (age <20) relative to those for mothers aged 20–24 years old, a group whose Medicaid eligibility was not affected by SCHIP policies.

Population Studied: Our raw sample of teenage and older mothers in Alaska, Oklahoma, South Carolina, Florida, Maine, New York, and West Virginia equaled 23,171 (811,638 weighted).

Results: SCHIP implementation was associated with an almost 10 percentage point increase in prepregnancy coverage among teens under age 17. Although there were increases in both public and private coverage only the latter was statistically significant. The only statistically significant increase in Medicaid coverage, equal to almost 16 percentage points, was among 18-year-olds in states with Medicaid expansion programs.

Conclusions: The temporary extension of SCHIP allows time to consider how to maintain the program's potentially positive effect on the reproductive health of adolescents.

From the *Rollins School of Public Health, Emory University, Atlanta, Georgia; †RTI International, Research Triangle Park, North Carolina; ‡Healthcare Administration Program, School of Business, University of Houston-Clear Lake, Texas Medical Center, Houston, Texas; and §National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia.

This research was funded by the Centers for Disease Control and Prevention (CDC) under CDC (PGO) 200-2002-00776 TO 12. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC.

Reprints: E. Kathleen Adams, PhD, Rollins School of Public Health, Department of Health Policy and Management, Emory University, 1518 Clifton Road, NE, Room 654, Atlanta, GA. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.