title: Medicaid enrollment policy increased smoking cessation among pregnant women but had no impact on birth outcomes.
abstract: Cigarette smoking during pregnancy is an important cause of poor maternal and infant health outcomes in the population eligible for Medicaid. These outcomes may be avoided or attenuated by timely, high-quality prenatal care. Using data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System for the period 2004-10, we examined the effects of two optional state Medicaid enrollment policies on smoking cessation, preterm birth, and having an infant who was small for gestational age. We used a natural experiment to compare outcomes before and after nineteen states adopted either of the two policies. The first policy, presumptive eligibility, permits women to receive prenatal care while their Medicaid application is pending. Its adoption led to a 7.7-percentage-point increase in smoking cessation but did not reduce adverse birth outcomes. The second policy, the unborn-child option, permits states to provide coverage to pregnant women who cannot document their citizenship or residency. Its adoption was not significantly associated with any of the three outcomes. The presumptive-eligibility enrollment policy will continue to be an important tool for promoting timely prenatal care and smoking cessation.
authors.affiliation: Marian Jarlenski (jarlenski@gmail.com) recently completed doctoral studies in health policy and management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland. In fall 2014 she will become an assistant professor of health policy and management at the Graduate School of Public Health, University of Pittsburgh, in Pennsylvania.
authors.forename: Marian
authors.initials: M
authors.lastname: Jarlenski
authors.affiliation: Sara N. Bleich is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Bleich
authors.affiliation: Wendy L. Bennett is an assistant professor of medicine in the Division of General Internal Medicine, Johns Hopkins University School of Medicine, in Baltimore.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Bennett
authors.affiliation: Elizabeth A. Stuart is an associate professor of mental health and biostatistics at the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.affiliation: Colleen L. Barry is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006291:Health Policy / Q000191:economics*; D049669:History, 16th Century; D006801:Humans; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics* / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States
keywords: Access To Care; Medicaid; PRAMS; Tobacco/Smoking