The impact of expanded health insurance coverage for unauthorized pregnant women on prenatal care utilization

Public Health Nurs. 2018 Nov;35(6):459-465. doi: 10.1111/phn.12524. Epub 2018 Jun 10.


Objective: The objective of this study was to investigate the effect of expanding Medicaid health insurance coverage for unauthorized women on prenatal care utilization.

Design and sample: A natural experiment design was used. We examined the prenatal care utilization of 20,876 unauthorized women from Nebraska, which expanded Medicaid coverage for unauthorized women, and South Carolina, which has never expanded coverage.

Measures: Measurements of prenatal care utilization included adequate prenatal care using the Kotelchuck Index and the number of prenatal care visits. The policy independent variable of interest was an interaction between the policy years (2007-2009) and Nebraska residence. Demographic characteristics were included as covariates. Analysis entailed a difference-in-difference approach to compare prenatal care utilization by state, both before and after legislation was passed to fund care among unauthorized women in Nebraska.

Results: Women with insurance coverage were more likely to utilize prenatal services. Unauthorized women living in Nebraska during Medicaid expansion were 28% more likely to receive adequate prenatal care (OR = 1.28, p < 0.01) and had about one more prenatal care visit (IRR = 1.05, p < 0.01) than women who did not have expanded Medicaid coverage.

Conclusions: Findings have important public health policy implications to support improved birth outcomes among native-born infants of unauthorized women.

Keywords: Medicaid; difference-in-difference; prenatal care; unauthorized.

MeSH terms

  • Adult
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Infant
  • Insurance Coverage*
  • Medicaid*
  • Pregnancy
  • Pregnancy Outcome
  • Prenatal Care / statistics & numerical data*
  • Undocumented Immigrants / statistics & numerical data*
  • United States
  • Young Adult