The effects of Florida's Medicaid eligibility expansion for pregnant women

Objectives. This is a study of the effects on prenatal care and birth outcomes of Florida's July 1989 expansion in the Medicaid income eligibility threshold for pregnant women. Methods. Concurrent and longitudinal comparisons were performed with matched birth and death certificates, hospital discharge data, Medicaid eligibility records, and records from county health departments for women giving birth from July 1988 to June 1989 (n = 56 101) or in calendar year 1991 (n = 78 421). Measures included amount and timing of prenatal care and rates of low birth-weight and infant deaths. Results. The Medicaid expansion led to greater access and improved birth outcomes. For example, the rate of low-birthweight infants among low-income women without private insurance fell from 67.9 to 61.8 per 1000, while it remained unchanged for low-income women with private insurance. Women in the expansion group who used county health departments had fewer low-birthweight infants than those using other delivery systems. Conclusions. The benefits from the Florida expansion appear to be greater than those reported for other states. The role of the public health delivery system may account for some of Florida's success.