The Impact of Citizenship Documentation Requirements on Access to Medicaid for Pregnant Women in Oregon

Abstract

The federal Deficit Reduction Act of 2005 mandated citizenship documentation from all Medicaid applicants as a condition of eligibility and was implemented in Oregon on September 1, 2006. We assessed whether new citizenship documentation requirements were associated with delays in Medicaid authorization for newly pregnant eligible applicants during the first nine months of DRA implementation in Oregon. We conducted a pre-post analysis of administrative records to compare the length of time between Medicaid application and authorization for all newly pregnant, Medicaid-eligible applicants in Oregon (n=29,284), nine months before and after September 1, 2006. We compared mean days from application to authorization (McNemar's), and proportion of eligible applicants who waited over 7, 30 and 45days to be authorized (Pearson's coefficient). The mean number of days women waited for authorization increased from 18days in the 9months before DRA implementation to 22.6days in the post-implementation 9month period (P≤.001). The proportion of eligible applicants who waited 7, 30 and 45days increased significantly following DRA implementation (P≤.001). The proportion of eligible applicants who were not authorized within the standard 45-day period increased from 6.9 to 12.5% following the DRA. Implementation of new citizenship documentation requirements was associated with significant delays in Medicaid authorization for eligible pregnant women in Oregon. Such delays in gaining insurance coverage can detrimentally affect access to early prenatal care initiation among a vulnerable population known to be at higher risk for certain preventable pregnancy-related complications.