Changes in Public Prenatal Care Coverage Options for Noncitizens Since Welfare Reform: Wide State Variation Remains

Med Care Res Rev. 2016 Oct;73(5):624-39. doi: 10.1177/1077558715616024. Epub 2015 Dec 15.


Before 1996, most lawfully present noncitizens were eligible for the same prenatal Medicaid benefits as U.S. citizens. However, the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA)-welfare reform-restricted benefits for certain lawful noncitizens for the first time. Welfare reform also gave states unprecedented authority to determine Medicaid eligibility. More recent federal policy changes have allowed states to cover some noncitizen pregnant women initially excluded under welfare reform. However, there are few comprehensive studies examining state implementation of these policy options. This study documents state-level trends in prenatal Medicaid and state-funded coverage options for low-income noncitizens just prior to and since welfare reform. While some states have substantially expanded prenatal coverage since PRWORA, wide variation remains. These findings have important implications for understanding the potential effects of the Affordable Care Act and Medicaid expansion on health care utilization and birth outcomes among pregnant noncitizens.

Keywords: immigrants; prenatal care coverage; state health policy.

MeSH terms

  • Eligibility Determination / legislation & jurisprudence
  • Emigrants and Immigrants / legislation & jurisprudence*
  • Female
  • Health Care Reform / legislation & jurisprudence*
  • Health Policy
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Medicaid / legislation & jurisprudence
  • Patient Protection and Affordable Care Act
  • Poverty
  • Pregnancy
  • Prenatal Care / statistics & numerical data*
  • Retrospective Studies
  • United States