Preconception and Prenatal Medicaid Coverage for Medicaid-Insured Births

Background: Medicaid provides insurance for 40% of U.S. births. Patterns of preconception Medicaid enrollment are not well-described. Methods: Using Medicaid Analytic Extract files, this retrospective cohort study of individuals with a 2014 Medicaid-insured birth examined months of Medicaid enrollment and changes in enrollment status during 84 months prior to birth. We used linear regression to assess the association between enrollment months and 2014 age, race and ethnicity, rural residence, any Medicaid eligibility due to disability, foster care involvement, or pregnancy, chronic health conditions, and state of residence. We examined variation across states in the relationship between enrollment months and changes in enrollment status. Results: We identified 944,068 individuals in 30 states. Individuals had a median of 40.6 (SD 27.3) enrollment months of Medicaid and 3.2 (SD 2.3) changes in enrollment status. Twenty-eight percent were enrolled in Medicaid for ≥63 months. In regression analysis, age, race and ethnicity, and chronic health conditions were associated with enrollment months. Each year of age was associated with -0.93 enrollment months (95% CI -1.27, -0.60). For chronic conditions, hypertension was associated with an additional 3.12 enrollment months (95% CI 2.53, 3.71), diabetes with 3.28 (95% CI 2.24, 4.32), and mental health with 6.27 (95% CI 5.55, 6.98). The relationship between enrollment months and changes in enrollment status varied across states. Conclusions: Medicaid plays a substantial role in preconception health insurance for individuals with Medicaid-insured births. This is particularly true for younger individuals and those with comorbidities associated with adverse birth outcomes.