Since expanded Medicaid coverage for pregnant women was implemented some fifteen years ago, this program has grown in importance as a source of financing prenatal care and delivery. The National Governors Association reports that Medicaid finances 37 percent of births nationally, about 1.5 million each year.  Medicaid coverage has been found to result in greater use of prenatal care, although nonfinancial barriers to care persist and other factors affect birth outcomes.  

Many women who are otherwise uninsured become eligible for Medicaid only once they are pregnant, as a result of more generous income eligibility criteria during pregnancy. This makes timely enrollment of newly-eligible pregnant women critical in ensuring access to early prenatal care. Medical Expenditure Panel Survey data for 1996-2001 show that among women enrolled in Medicaid at delivery, only half were enrolled 12 months earlier.  Some 21 percent enrolled late, during the last 3 months of pregnancy.

State policies and practices can encourage timely enrollment. Some 29 states have adopted presumptive eligibility for pregnant women, under which temporary coverage is provided until final eligibility is determined.   Simplified application forms and streamlined enrollment procedures such as accepting applications by mail or through provider offices, limiting required income verification documentation, and providing multilingual application materials have been found to increase participation children eligible for Medicaid or the State Children’s Health Insurance Program. 

Some 29 states require pregnant women to enroll in managed care plans for their care, which has the potential to result in delayed care.  Studies have shown mixed findings regarding the effects of managed care on use of prenatal care.  More recently, some states have proposed changes that would require Medicaid beneficiaries to choose coverage from among a variety of private plans.

Scope of Work

The March of Dimes seeks proposals for a study of outreach and enrollment of pregnant women in Medicaid. The study should identify ways in which states might improve timely enrollment of Medicaid-eligible pregnant women. The study approach is expected to include a review of existing literature and, as appropriate, collection of new information through expert interviews, case studies, or a telephone survey. 

Key research questions may include:

• What factors explain why some eligible women are not enrolled in Medicaid until late in pregnancy?
• How do states inform women about the availability of Medicaid benefits during pregnancy? How are language, health literacy, and cultural differences addressed?
• What strategies have been found most effective in encouraging timely eligibility determination for pregnant women?
• Have efforts to expand Medicaid participation of eligible children and families through simplified enrollment forms and procedures also improved timely enrollment of pregnant women?  What simplification approaches are most effective for this population? How do requirements for face-to-face interviews, citizenship verification, and treatment of potential absent parent medical support affect timely enrollment of pregnant women?
• Does coordination with the State Children’s Health Insurance Program, Title V, and other state programs expedite Medicaid eligibility determination for pregnant women?
• Twenty states have received or are awaiting approval of waivers to provide family planning services to women (and in some cases men) not otherwise eligible for Medicaid.  Is early enrollment in Medicaid for pregnancy-related services expedited for women already participating in Medicaid family planning programs? 
• What state efforts are most effective in ensuring early enrollment of pregnant teenagers?
• What strategies are most effective in enrolling pregnant women into the appropriate health care delivery system once eligibility has been determined? Do requirements for enrollment in managed care plans or other private coverage affect Medicaid enrollment or timely access to prenatal care services?

Interested researchers should contact: Lisa Potetz, Director, Public Policy Research, Office of Government Affairs, March of Dimes, 1146 19th Street, NW, Sixth Floor Washington, DC 20036, lpotetz@marchofdimes.com, Proposals must be received by April 28, 2006.

About the March of Dimes

The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects and infant mortality.  Founded in 1938, the March of Dimes funds programs of research, community services education and advocacy to save babies.