The Impact of Citizenship Documentation Requirements on Access to Medicaid for Pregnant Women in Oregon
The federal Deficit Reduction Act of 2005 mandated citizenship documentation from all Medicaid applicants as a condition of eligibility and was implemented in Oregon on September 1, 2006. We assessed whether new citizenship documentation requirements were associated with delays in Medicaid authorization for newly pregnant eligible applicants during the first nine months of DRA implementation in Oregon. We conducted a pre-post analysis of administrative records to compare the length of time between Medicaid application and authorization for all newly pregnant, Medicaid-eligible applicants in Oregon (n = 29,284), nine months before and after September 1, 2006. We compared mean days from application to authorization (McNemar’s), and proportion of eligible applicants who waited over 7, 30 and 45 days to be authorized (Pearson’s coefficient). The mean number of days women waited for authorization increased from 18 days in the 9 months before DRA implementation to 22.6 days in the post-implementation 9 month period (P ≤ .001). The proportion of eligible applicants who waited 7, 30 and 45 days increased significantly following DRA implementation (P ≤ .001). The proportion of eligible applicants who were not authorized within the standard 45-day period increased from 6.9 to 12.5% following the DRA. Implementation of new citizenship documentation requirements was associated with significant delays in Medicaid authorization for eligible pregnant women in Oregon. Such delays in gaining insurance coverage can detrimentally affect access to early prenatal care initiation among a vulnerable population known to be at higher risk for certain preventable pregnancy-related complications.
KeywordsPrenatal Care Eligible Woman Social Security Administration Medicaid Coverage Medicaid Eligibility
The Oregon Department of Children Adolescents and Families provided the dataset used for this analysis and assistance with data coding. Dr. DeVoe’s time on this project was supported by grant number K08-HS16181 from the Agency for Healthcare Research and Quality (AHRQ). Ms. Bauer received a stipend from the Human Resources Services Association (HRSA) Maternal Child Health Bureau through the Graduate Student Internship Program to complete research with the Oregon Office of Family Health. The authors report no conflict of interest within the last three years. There was no financial support provided by the NIH, Wellcome Trust, or HHMI for this research. These findings were presented at the 2009 American Public Health Association Conference Maternal Child Health poster session, November 11, 2009. No funding for this research was received from the National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute or other grant-making institutions.
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