The Impact of Medicaid Policy on Prenatal Care Utilization and Pregnancy Outcomes of Immigrant Women

An alarm has sounded regarding a maternal health crisis in the US and policy makers and public health officials have begun to address health care inequalities that likely contribute to the maternal health crisis. One group that has received inadequate attention is immigrant women. Many immigrant women face a maternal health disadvantage with some immigrant groups experiencing increase risk of severe maternal morbidity and obstetric complications. Moreover in contrast to decades of research showing an overall protective effect of foreign-born status on pregnancy outcomes more recent research realizes that some subgroups of infants are at increased risk of adverse outcomes and that outcomes deteriorate among immigrant women and children over time. Analyses of Medicaid expansion have overall pointed to a favorable effect on prenatal care utilization an important component of maternal and infant health as well as low birth weight and preterm birth. However expansion policies largely excluded many categories of immigrant women potentially accelerating the health deterioration experienced by immigrant women and children. Using US birth certificate data over the period 2011-2017 we will estimate the effect of Medicaid policy restrictions on immigrant women's access to prenatal care and adverse pregnancy outcomes that are a result of preconception and prenatal Medicaid policies toward immigrant women. We will accomplish this by leveraging the differential expansion of Medicaid to immigrant versus non-immigrant women across US states. Our project works toward the MCHB Goal: Eliminate Health Barriers and Disparities and addresses MCHB Strategic Research Issue II 'MCH services and systems of care efforts to eliminate health disparities and barriers to health care access for MCH populations.' Our findings will provide evidence for the Title V MCH Services Block Grant-National Performance Domains '1 Well-Woman Visits and Preconception/ Interconception Health Maternal Health' and '15 Adequate Insurance Coverage Cross-Cutting/Life Course'. Our findings on the impact of Medicaid policy on immigrant maternal health will also further the evidence base for HRSA clinical priority area of maternal mortality. Our project targets the Healthy People 2020 goals: Reduce the rate of maternal mortality; Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery); Reduce low birth weight (LBW) and very low birth weight (VLBW); Reduce preterm births; and Increase the proportion of pregnant women who receive early and adequate prenatal care.