Presumptive eligibility for pregnancy Medicaid and timely prenatal care access

Objective To assess the association between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access. Data Source 2012-2019 National Center for Health Statistics natality files. Study Design We used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education. Outcomes included first-trimester prenatal care, the month of first prenatal visit, and adequate prenatal care. Data Collection/Extraction Methods All live births among adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming. Principal Findings Among all births, we found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with a 1.92 percentage-point increase (95% CI: 0.64, 4.35) in first-trimester prenatal care, driven by earlier month of first prenatal care visit. Conclusions Presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care among individuals with lower education, but other interventions may be needed.