*Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health †Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine ‡Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2014 Jan;52(1):10-9. doi: 10.1097/MLR.0000000000000020.
The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would otherwise have difficulty enrolling in or would be ineligible for Medicaid.
To examine the association of the UC option with the probability of enrollment in Medicaid/CHIP during pregnancy and probability of receiving adequate prenatal care.
We use pooled cross-sectional data from the Pregnancy Risk Assessment Monitoring System from 32 states between 2004 and 2010 (n = 81,983). Multivariable regression is employed to examine the association of the UC option with Medicaid/CHIP enrollment during pregnancy among eligible women who were uninsured preconception (n = 45,082) and those who had insurance (but not Medicaid) preconception (n = 36,901). Multivariable regression is also employed to assess the association between the UC option and receipt of adequate prenatal care, measured by the Adequacy of Prenatal Care Utilization Index.
Residing in a state with the UC option is associated with a greater probability of Medicaid enrollment during pregnancy relative to residing in a state without the policy both among women uninsured preconception (88% vs. 77%, P < 0.01) and among women insured (but not in Medicaid) preconception (40% vs. 31%, P < 0.01). Residing in a state with the UC option is not significantly associated with receiving adequate prenatal care, among both women with and without insurance preconception.
The UC option provides states a key way to expand or simplify prenatal insurance coverage, but further policy efforts are needed to ensure that coverage improves access to high-quality prenatal care.
“胎儿”（UC）选项为州医疗补助/儿童健康保险计划（CHIP）提供了一项新策略，以扩大对低收入妇女的产前覆盖范围，这些妇女在参加医疗补助或不符合医疗补助资格方面有困难。
检查 UC 选项与怀孕期间参加医疗补助/CHIP 的可能性以及获得足够产前护理的可能性之间的关联。
我们使用 2004 年至 2010 年来自 32 个州的妊娠风险评估监测系统的汇总横截面数据（n = 81983）。多变量回归用于检查符合条件的未参保孕妇（n = 45082）和有保险（但没有医疗补助）的孕妇（n = 36901）中 UC 选项与怀孕期间参加医疗补助/CHIP 的关联。多变量回归也用于评估 UC 选项与获得足够产前护理的关联，通过产前护理利用充足度指数来衡量。
与没有该政策的州相比，居住在有 UC 选项的州的妇女在怀孕期间参加医疗补助的可能性更大，无论是未参保的孕妇（88%对 77%，P < 0.01）还是有保险（但没有医疗补助）的孕妇（40%对 31%，P < 0.01）。居住在有 UC 选项的州与未参保和参保孕妇获得足够的产前护理均无显著关联。
UC 选项为各州提供了扩大或简化产前保险覆盖范围的关键途径，但需要进一步的政策努力，以确保覆盖范围改善获得高质量产前护理的机会。
