LOCAL RESPONSES TO EXPANDED MEDICAID COVERAGE FOR PREGNANT-WOMEN

Concern about high infant mortality and morbidity in the United States , combined with the erosion of private insurance coverage, sparked maj or expansions in the Medicaid program in the 1980s. This study examine s how the Medicaid expansions for pregnant women affected access to pr enatal care for low-income women through case studies conducted in fou r states early in 1991. Despite the significantly greater share of bir ths covered by Medicaid in the period 1986 to 1991, the timely initiat ion of prenatal care improved in only one state. Although prenatal ser vices increased in some areas, significant problems persisted in other s. The growth in capacity of the prenatal care system was greatest whe n state and local policies designed to increase supply were also insti tuted. While the Medicaid expansions eliminated significant barriers t o prenatal care for low-income women, other policies that have been de signed to reduce the remaining barriers may be necessary in order sign ificantly to expand access to prenatal care and to improve birth outco mes.