Access to prenatal care following major Medicaid eligibility expansions.
OBJECTIVE
To determine whether lack of financial access was a significant barrier to prenatal care following major expansions of Medicaid eligibility in California.


METHODS
Retrospective analysis of birth certificates, assessing risks of inadequate prenatal care by insurance, controlling for maternal race/ethnicity, birthplace, age, parity, education, and marital status.


METHODS
Singleton live births to California residents occurring in-state in 1990 (N = 593,510).


METHODS
Untimely initiation of care, two few visits, and no prenatal care.


RESULTS
Despite major Medicaid expansions, nearly 11% of live births were uninsured for prenatal care. Being uninsured and having Medi-Cal were both risk factors of sizable magnitude, controlling for maternal characteristics. Compared with women who had private fee-for-service coverage, uninsured women were at elevated risk of untimely initiation (odds ratio [OR], 2.54; 95% confidence interval [CI], 2.47 to 2.60) and too few visits (OR, 2.49; 95% CI, 2.44 to 2.55). Women with Medi-Cal had a high risk of untimely care (OR, 3.33; 95% CI, 3.26 to 3.40); their risk of too few visits was also elevated (OR, 1.63; 95% CI, 1.60 to 1.66) but less than for the uninsured. Lack of private insurance was a strong risk factor for no care (OR, 6.70; 95% CI, 6.00 to 7.47).


CONCLUSIONS
In spite of major Medicaid expansions, access to prenatal care was limited for women without private insurance. Medicaid was associated with untimely entry but with improved continuity. The findings suggest that financial barriers were salient even when controlling for many factors related to care-seeking behavior. Policy initiatives need to address continuing financial barriers along with other obstacles.
Braveman
P
P
Department of Family and Community Medicine, University of California, San Francisco 94143.
Bennett
T
T
Lewis
C
C
Egerter
S
S
Showstack
J
J
D000293:Adolescent; D000328:Adult; D002140:California; D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States