Impact of SCHIP on racial disparities in Medicaid enrollment and prenatal care initiation among pregnant teens and young adults in Florida

Background: All low-income women who become pregnant are eligible for Medicaid. However, waiting until pregnant to enroll may result in late initiation of prenatal care and poor birth outcomes. Blacks initiate prenatal care later and have poorer birth outcomes than their white peers. Expansion of Medicaid coverage, regardless of pregnancy, to poor, single young adults has been proposed as a means of reducing these disparities.

Objectives: We examined whether pregnant teens enrolled in Medicaid were more likely to have insurance pre-pregnancy and initiate prenatal care early after the expansion of public insurance coverage with the implementation of the State Children's Health Insurance Program (SCHIP) and the accompanying increase in Medicaid take-up. We also examined whether racial disparities in these measures narrowed after Medicaid expansion.

Methods: We used Florida Medicaid claims for teens aged 11-19 and young adults aged 20-24 with a delivery in fiscal years 1995 (pre-SCHIP) or 2001 (post-SCHIP). We examined two measures: (1) enrolled 9 or more months prior to delivery, and (2) late-initiated or no Medicaid-covered PNC. We ran multivariate models controlling for selected medical risk factors and county-level contextual factors.

Results and Discussion: Early enrollment improved for both teens and young adults whereas early initiation of prenatal care improved for teens only. Racial disparities narrowed for early enrollment but not for early initiation of prenatal care.