Insurance Coverage, Use of Prenatal Care, and the Financing of Birth Outcomes in Nine States Pre and Post Welfare Reform

How does the Personal Responsibility and Work Opportunity Reconciliation Act 's (PRWORA) de-coupling of cash assistance from Medicaid affect insurance status and access to and utilization of prenatal care for low-income pregnant and childbearing women? Researchers at Emory University tested two hypotheses: 1) low-income women are less likely to be insured prior to and during pregnancy as a result of PRWORA; and, 2) decreased enrollment in Medicaid due to PRWORA will make it more likely that low-income women delay prenatal care, resulting in poor birth outcomes and increased need for financial resources following birth. They speculated that even if the rate of Medicaid-funded births remains steady, the costs of caring for high-risk infants rises because of the increase in uninsurance prior to delivery. The objective of this project was to inform state and federal policymakers about the effects of welfare reform on having insurance, accessing care, and costs of care for both women and infants.