title: Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?
abstract: OBJECTIVE
  To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy.
  
  
  METHODS
  The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage.
  
  
  RESULTS
  Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively.
  
  
  CONCLUSIONS
  Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.
authors.affiliation: Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor, Chicago, Illinois, 60612, USA. drose@uic.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: Rosenberg
authors.forename: Arden
authors.initials: A
authors.lastname: Handler
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Rankin
authors.forename: Meagan
authors.initials: M
authors.lastname: Zimbeck
authors.forename: E Kathleen
authors.initials: EK
authors.lastname: Adams
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001719:Birth Certificates; D016009:Chi-Square Distribution; D004608:Eligibility Determination / Q000331:legislation & jurisprudence; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008429:Maternal Welfare / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D008484:Medicaid / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D011203:Poverty / Q000208:ethnology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data