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Presumptive eligibility for pregnant Medicaid enrollees: its effects on prenatal care and perinatal outcome.

J M Piper, E F Mitchel, Jr and W A Ray

Preventive Medicine Department, Vanderbilt University, Nashville, TN 37232-2637.

OBJECTIVES. "Presumptive eligibility" permits pregnant prospective Medicaid enrollees to obtain services during the application period. The purpose of this study was to assess the effects of presumptive eligibility on the receipt of prenatal care and the occurrence of low-birthweight births and neonatal, perinatal, and infant mortality. METHODS. Outcome rates for pregnant women who enrolled in Tennessee Medicaid in the 6-month period before presumptive eligibility was enacted were compared with those obtained for pregnant women who enrolled in the 6-month period after presumptive eligibility had been in effect for 5 months. RESULTS. Women in the "after" group were 40% more likely to enroll and 30% more likely to obtain prenatal care in the first trimester. They were 300% more likely to fill a prescription for prenatal vitamins in the first trimester and 16% more likely to have begun prenatal care before the third trimester. However, they were similar to those enrolling in the "before" time period in terms of the occurrence of adverse perinatal outcomes. CONCLUSIONS. When barriers to prenatal care, including bureaucratic ones, are removed, low-income women will seek care earlier and more frequently.

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