State Approaches to Simplify Medicaid Eligibility and Implications for Inequality of Infant Health

Along with the late 1980s Medicaid expansion for pregnant women and children, states implemented multiple reforms to reduce administrative burdens and facilitate access to Medicaid and prenatal care. We use National Vital Statistics birth data 1985-1994 and a difference-in-discontinuities approach to compare the effectiveness of these reforms for improving infant health and access to prenatal care. Results indicate that combinations of reforms to reduce administrative burdens increased Medicaid enrollment and improved infant health nearly as much as Medicaid expansion. In most cases, these reforms yield larger benefits for racially and socioeconomically marginalized mothers, but targeted reforms could better address unequal barriers and further improve equality. Benefits of the reforms are larger in states with more physicians per capita, particularly for marginalized mothers. Overall, results suggest combined policy responses to reduce multiple burdens at the same time are needed to address unequal barriers.