# Effects of state immigrant insurance coverage policies on access to adequate prenatal care among immigrant pregnant women in the United States

## TL;DR

This study shows that expanding insurance coverage for immigrant pregnant women in the U.S. improves their access to timely and adequate prenatal care.

## Contribution

The novel contribution is identifying that state-funded immigrant insurance policies significantly enhance prenatal care quality and timing for immigrant mothers.

## Key findings

- State-funded immigrant insurance policies increased odds of adequate prenatal care by 72% and reduced inadequate care by 52%.
- These policies led to an 87.1 percentage point increase in first-trimester care initiation and significant decreases in delayed or no prenatal care.
- Only state-only funded policies consistently improved prenatal care adequacy compared to other approaches.

## Abstract

The 1996 federal welfare and immigration reform restricted immigrant eligibility for public health insurance such as Medicaid and CHIP. As of January 2023, 34 states have adopted policies to expand insurance coverage for immigrant pregnant individuals through Medicaid/CHIP.

To estimate the effects of state immigrant insurance policies on prenatal care utilization and timing among pregnant immigrants.

A difference-in-differences approach was used to compare states that expanded immigrant insurance coverage to those that did not. The main data source is the restricted natality data from the National Center for Health Statistics, including all singleton births to immigrant mothers aged 15–44 across all 50 states and D.C. from 2015 to 2019.

In states adopting the State-only funds option, publicly insured immigrants had higher odds of receiving intermediate (OR: 1.429; 95 % CI: 1.210–1.687), adequate (OR: 1.723; 95 % CI: 1.526–1.946), and adequate plus (OR: 1.373; 95 % CI: 1.256–1.500) prenatal care, and lower odds of inadequate care (OR: 0.480; 95 % CI: 0.406–0.568) compared to uninsured immigrants. Additionally, this policy was associated with an 87.1 percentage point increase in first-trimester care initiation (95 % CI: 1.622–2.159), and significant decreases in delayed care (−43.8 pp; 95 % CI: 0.430–0.736) and no care until delivery (−67.3 pp; 95 % CI: 0.204–0.522) for publicly insured immigrant populations compared to uninsured immigrants.

Expanding immigrant insurance coverage was associated with earlier and more adequate prenatal care. However, only State-only funds showed consistent improvements in the adequacy of prenatal care utilization.