THE MEDICAID ELIGIBILITY EXPANSIONS FOR PREGNANT-WOMEN - EVALUATING THE STRENGTH OF STATE IMPLEMENTATION EFFORTS

Surveys of state Medicaid agencies and maternal and child health progr ams were conducted in late 1991 and in 1992 to evaluate the extent to which states carried out a series of federal policy changes intended t o improve low-income women's access to prenatal care. The results show a great deal of variability in the aggressiveness with which states i mplemented these Medicaid eligibility expansions. Overall, North Carol ina, Maryland, Massachusetts, New York and Arkansas moved most aggress ively to carry out the expansions, Kansas, Nebraska, South Dakota, Nor th Dakota and Wyoming were ranked least aggressive. States with relati vely high levels of poor birth outcomes or low-birth- weight deliverie s prior to the Medicaid expansions were generally more likely than oth er states to have undertaken reforms intended to increase the number o f women eligible for assistance and ease their enrollment. In addition , expansion efforts were greater in states where the federal governmen t paid more of the cost of caring for Medicaid recipients.