Medicaid Outreach and Enrollment for Pregnant Women: What Is the State of the Art?

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Abstract

This Urban Institute study, with partner the National Academy for State Health Policy, presents findings from a 50-state analysis of Medicaid outreach and enrollment strategies targeting pregnant women. The study finds significant variation across states, but observes that the majority have policies to facilitate pregnant women's access to coverage through simplified enrollment; however, there is considerable room for improvement in outreach efforts and enhanced prenatal care. The paper presents policy recommendations for state officials to facilitate enrollment of pregnant women, raise public awareness of available coverage, and broaden the scope of prenatal care. The March of Dimes funded this study.

Introduction

Over the past twenty years, the United States has experienced divergent trends in birth outcomes, with some key indicators improving and others worsening. For example, rates of infant mortality have steadily fallen and the proportion of mothers who enter into prenatal care early has steadily risen, yet rates of preterm, low, and very low birth-weight births have all increased. Furthermore, serious racial disparities in these outcomes have persisted, with African American women and children, in particular, experiencing significantly worse outcomes.

During that same time period, the level of attention that federal and state policymakers have focused on publicly sponsored health insurance for pregnant women has fluctuated. The late 1980s and early 1990s marked an era when states and the federal government made concerted efforts to improve birth outcomes for vulnerable women and infants by improving access to prenatal care, as states made significant expansions in Medicaid eligibility followed by large investments in outreach, enrollment simplification, and the enhancement of prenatal benefits. In the last ten years, however, since the creation of the State Children’s Health Insurance Program in 1997, children’s coverage expansions arguably have received the lion’s share of the attention of policymakers concerned with maternal and child health.

Finally, the last two decades have also witnessed major changes within health care delivery and financing systems, with dramatic expansion in the use of managed care for Medicaid enrollees (including mothers and children), as well as new family planning initiatives that target low-income women of childbearing age.

Given these trends, and the fact that no study has comprehensively looked at state Medicaid programs’ perinatal policies in nearly a decade, the March of Dimes asked the Urban Institute and its partner—the National Academy for State Health Policy—to assess the current “state of the art” of state Medicaid program efforts to reach out to and enroll pregnant women into coverage. The purpose of this project would be two-fold: (1) to develop a 50-state database on state Medicaid program strategies for outreach, enrollment, and coverage of this population; and (2) to identify a range of “best practices,” based on our detailed analysis of states making special and innovative efforts in these areas. Ultimately, the product of this research would be a policy report that the March of Dimes and its state chapters across the United States could use to influence policy improvements at the national and state levels.

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