Improving early access to prenatal care: Medicaid outreach and enrollment strategies for pregnant women

During the late-1980s, to address worsening birth outcomes, state Medicaid programs dramatically expanded coverage for pregnant women and engaged in aggressive outreach and enrollment simplification. Since then, Medicaid has become the largest payer for deliveries nationwide. Twenty years later, this study examines the current “state of the art” of Medicaid outreach and enrollment of pregnant women, and identifies state “best practices.”

With funding from the March of Dimes, a 50-state survey of Medicaid agencies was conducted, followed by in-depth telephone interviews and case studies in selected states.

We find that states continue to place high priority on pregnant women and maintain a variety of strategies for facilitating coverage, including statewide media campaigns to publicize the availability of coverage, community-based outreach to target high-risk populations, outreach materials printed in multiple languages, and toll-free information hotlines. States also continue to emphasize simplified enrollment by shortening Medicaid applications, allowing online and mail submission, outstationing eligibility workers at health care settings, and offering presumptive eligibility.

States such as New York, Louisiana, Michigan, and New Mexico, have been particularly innovative, adopting multi-faceted strategies that include “street” outreach by Community Health Workers, nurse home visiting for high-risk mothers, specialized eligibility workers that provide hands-on application assistance in public health agencies, expedited eligibility processing, and rapid referral to prenatal care.

Still, in the context of health care reform, states could make better use of federal optional authority to expand eligibility above the statutory minimum, and further invest in outreach, enrollment simplification, and enhanced prenatal care.