{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:45:40Z","timestamp":1783611940743,"version":"3.55.0"},"reference-count":54,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006458","name":"Children's Hospital of Philadelphia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006458","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011125","name":"School of Medicine and Dentistry, University of Rochester","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of increased Medicaid income eligibility during pregnancy on payment source for prenatal care and birth and on gestational age at birth (GAb).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We performed a quasi\u2010experimental, difference\u2010in\u2010differences study comparing two increases in Medicaid income eligibility during pregnancy to two control states with data from 2007 to 2010: (Dyad 1) Ohio (expanded from 150% to 200% of the Federal Poverty level [FPL]) versus Pennsylvania and (Dyad 2) Wisconsin (185% to 250% FPL) versus Michigan. We performed multinomial logistic regression to assess the impact of increased Medicaid eligibility on the following key outcome variables: payment source for prenatal care and birth and GAb.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We utilized CDC Pregnancy Risk Assessment Monitoring System (PRAMS) data (2007\u20132010) and limited analysis to singleton, in\u2010state live births. After re\u2010weighting for PRAMS survey design, our analytical sample represented about 540,000 births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>In the higher\u2010income Wisconsin\u2010Michigan dyad, increased Medicaid eligibility during pregnancy significantly increased exclusive Medicaid coverage for prenatal care (7.0%, 95% CI 2.9% to 11.1%) and birth (8.3%, 4.3% to 12.4%). Simultaneously, private insurance coverage dropped for prenatal care (\u22124.0%, \u22127.7% to \u22120.3%) and birth (\u22123.7%, \u22127.2% to \u22120.2%) while self\u2010payment decreased only for birth (\u22121.8%, \u22123.5% to \u22120.2%). In the lower\u2010income Ohio\u2010Pennsylvania dyad, the only statistically significant effects on payment source were decreases in the likelihood of a payment source of other for prenatal care (\u22123.3%, \u22126.2% to \u22120.3%) and birth (\u22124.7%, \u22127.9% to \u22121.6%). There were no statistically significant effects on GAb across both dyads.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased Medicaid eligibility during pregnancy for individuals of higher income seems to improve utilization of exclusive Medicaid with diminished uninsurance but also less private insurance after accounting for indicators of socioeconomic advantage but has no clear impact on GAb. Medicaid policy should balance reducing uninsurance with directing scarce resources to high\u2010risk individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70037","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T03:20:10Z","timestamp":1757906410000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Increased Medicaid Eligibility During Pregnancy on Medicaid Utilization and Gestational Age"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3938-7490","authenticated-orcid":false,"given":"Nicolas P.","family":"Goldstein Novick","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4566-7696","authenticated-orcid":false,"given":"Peter J.","family":"Veazie","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine L.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva K.","family":"Pressman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Rochester Medical Center Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Szilagyi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, David Geffen School of Medicine At UCLA Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Nelin","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Lorch","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","first-page":"373","article-title":"Changes in Prenatal Care Timing and Low Birth Weight by Race and Socioeconomic Status: Implications for the Medicaid Expansions for Pregnant Women","volume":"36","author":"Dubay L.","year":"2001","journal-title":"Health Services Research"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/016327878901200404"},{"key":"e_1_2_11_4_1","first-page":"1","volume-title":"MEDICAID: States Expand Coverage for Pregnant Women, Infants, and Children","author":"Zimmerman M.","year":"1989"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2307\/2135414"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/262059"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03450170067024"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)30625-1"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500010097040"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.84.10.1626"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.5034\/inquiryjrnl_47.04.315"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.2307\/3350285"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)30178-8"},{"issue":"4","key":"e_1_2_11_14_1","first-page":"85","article-title":"Impact of Medicaid Expansion on Early Prenatal Care and Health Outcomes","volume":"19","author":"Epstein A. 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