OBJECTIVES: Arkansas expanded Medicaid in 2014 by purchasing coverage in Qualified Health Plans (QHP) for newly eligible enrollees with incomes below 138% of the federal poverty limit. However, women pregnant at the time of application were assigned to traditional Medicaid, while women who became pregnant after assignment to a QHP maintained coverage in a QHP. This study compares prenatal care outcomes for women who were covered by Arkansas Medicaid and a QHP.

METHODS: Mothers with live-births occurring on or between 01/09/2014 and 01/30/2015 and recorded in medical claims records and Arkansas birth certificate records were selected in the study. Mothers were required to be enrolled for at least 43 days prior and 56 days after delivery in either Medicaid or QHP without switching between plans. A propensity score approach was employed to match (1:1) pregnant women in the two cohorts utilizing important socio-demographic characteristics, previous pregnancies, WIC (Woman, Infant, Children) program status, single/multiple birth status, and number of days enrolled. The outcomes of interest number of prenatal visits and the time to first prenatal visit (in days) were modeled using Poisson regression and ordinary least square regression respectively while accounting for clustering at the matched pair level.

RESULTS: The final matched sample comprised of 4738 mothers with a mean age of 26.36 and an average enrollment of 273.65 days prior to delivery. The analysis of the matched sample demonstrated that QHP enrollment was associated slightly more prenatal visits (11.00 vs 10.55; p<0.001). Similarly, QHP enrollment was also associated with earlier access to prenatal care (81.89 days vs 90.81 days; p<0.001).

CONCLUSIONS: QHP enrollment was associated with small improvements in access to prenatal care. Additional research is warranted to determine if these small gains in access confer better maternal and infant outcomes.