Impact of the Medicaid Eligibility Expansions on Coverage of Deliveries

Abstract

C ongress enacted the policy changes known collectively as the Medicaid eligibility expansions beginning in the mid-1980s and continuing through the late 1980s.1 The principal aim of the expansions was to increase low-income women's access to prenatal care and improve the quantity and quality of prenatal care they received. However, concern arose from the beginning that their primary impact might be to increase the number of Medicaid-funded deliveries rather than increase women's use of Medicaid-subsidized prenatal care. No one has yet attempted to measure the national impact of the Medicaid expansions on women's use of prenatal care. The few studies that have evaluated the impact of these expansions in individual states have found mixed results, at best.2 However, data from a recently completed study of the efforts of states to implement the Medicaid expansions (a study that did not address the question of impact on prenatal care)3 can be used to analyze whether Medicaid-subsidized births have increased since the expansions began. The study, fielded in November 1991, included a survey of directors of Medicaid agencies in the 50 states and the District of Columbia. We asked recipients to provide the number of Medicaid-funded deliveries in their state during FY 1991. Nevada, Tennessee and Virginia were unable to provide these data; Alaska and Rhode Island did not respond to the survey. Thus, we have not made estimates for these five states. A sirnilar survey, conducted by The Alan Guttmacher Institute in 1985, produced data on the annual number of deliveries covered by Medicaid for around 19841985* (before the expansions).4 The proportion of births paid for by Medicaid in 1985 is presented here for all states; estimates were made for the 15 states that were unable to provide information on Medicaid-funded deliveries in the 1985 survey. We also relate the Medicaid data to the total number of births in each of the two years to obtain the proportion of women giving birth whose deliveries were covered by Medicaid. Comparison of the proportions for 1985 and 1991 yields a measure of the impact of the expansions on Medicaid coverage of deliveries.