Beginning in 1990, California's Medicaid program, MediCal, expanded prenatal care coverage to more low-income women. The result was a substantial reduction in inadequate use of prenatal care in 1995 and 1998 and fewer women who were uninsured or self-paying compared with 1990, according to a study supported by the Agency for Healthcare Research and Quality (HS10856). The proportion of live-born infants whose mothers had inadequate prenatal care (first physician visit after the fourth month of pregnancy) decreased from 20 percent in 1990 to 14 percent in 1995 and 12 percent in 1998. Also, the proportion of pregnant women who had no insurance or were self-paying fell from 13.1 percent in 1990 to 4.2 percent in 1995 and 3.6 percent in 1998.
These improvements could be attributable to easier enrollment (due to a shortened application form) and expanded eligibility, which enabled more newly enrolled pregnant women to initiate prenatal care within the first trimester. In contrast, improvements were smaller among women with private insurance, who were more likely to obtain insurance before pregnancy. The smaller improvements in the private insurance and other public groups suggest that other factors are important, including programs that promote awareness of the need for early prenatal care.
Although there have been improvements, easier access has not resulted in full use of prenatal care. Expanded Medicaid eligibility eases financial barriers but does not directly address nonfinancial barriers involving awareness of the importance of early prenatal care, knowledge of Medicaid eligibility, availability of providers who accept Medicaid patients, and transportation to the sites where care is available. To further reduce ethnic disparities in use of prenatal services, the researchers call for the development of new policies to remove nonfinancial barriers to early and continuous use of prenatal care. Their findings are based on analysis of California birth certificate data for 1990, 1995, and 1998, which included information on prenatal care insurance.
See "Reduced risk of inadequate prenatal care in the era after Medicaid expansions in California," by Nancy A. Hessol, M.S.P.H., Eric Vittinghoff, Ph.D., and Elena Fuentes-Afflick, M.D., M.P.H., in the May 2004 Medical Care 42(5), pp. 416-422.