Medicaid, a public insurance program that serves many poor women and children, has undergone extensive changes since the mid-1980s. Work evaluating these changes has focused exclusively on increases in the generosity of income cutoffs for Medicaid eligibility. This research has shown that many eligible pregnant women remain uncovered throughout much of their pregnancies. States have responded with informational programs and with procedural changes designed to make it easier for women to enroll. This application will evaluate the effects of these changes on enrollments, prenatal care, maternal behaviors, and infant outcomes over the years 1988 to 1998. Primary data sources include the Survey of Income and Program Participation (for the analysis of enrollments) and the Vital Statistics Detail Natality data (a census of birth certificates). The large size of the VSDN data will allow us to ask whether the effects of these changes vary with the racial and ethnic characteristics of the mother, as well as with age, education, and immigrant status, which is important because the previous literature suggests that non-price barriers to care may vary between these groups. Some information about outreach and procedural changes has been assembled for this application from National Governor's Association newsletters. A key contribution of this project will be the collection of more comprehensive data on these changes, data that will assembled by direct contact with state agencies.
