Medicaid Outreach and Enrollment
THE URBAN INSTITUTE
for Pregnant Women:
What is the State of the Art?
Prepared by:
Ian Hill and Brigette Courtot
The Urban Institute
and
Shelly Gehshan, Andrew Snyder, Dan Belnap and Mary Takach
National Academy for State Health Policy
for
The March of Dimes
Presented to:
NASHP Annual Meeting, Denver, CO
15 October 2007

Outline of Presentation
• Background on our study
• Refocusing on early access to prenatal care
• History of Medicaid outreach and
enrollment for pregnant women
• Preliminary findings
• Next Steps
THE URBAN INSTITUTE

Project Background
• Goal: To determine the current “state of the art” of
Medicaid outreach and enrollment for pregnant
women; provide March of Dimes chapters with
insights into “best practices” to advocate for
• Team: Urban Institute and NASHP
• Scope of work:
- Literature review
- 50-state email survey
- Site visits/case studies of four states
THE URBAN INSTITUTE

Why Renew our Focus on
Prenatal Care?
Divergent Trends:
• Infant mortality continues to drop
• Early entry into prenatal care has improved
However:
• Rate of pre-term births has increased
• Rate of LBW and VLBW has increased
• Serious racial disparities persist
Timely Prenatal Care Remains a Wise Investment
THE URBAN INSTITUTE

History: Medicaid Expansions for
Pregnant Women
• OBRA-86, -87, and -89 dramatically expanded
financial access to Medicaid perinatal coverage
• Tools in law triggered unprecedented efforts to
simplify enrollment procedures
• Eligibility simplification was coupled with
multi-faceted outreach efforts
• Enhanced prenatal benefits improved content of
care
THE URBAN INSTITUTE

By the early 1990s…
• Almost half the states set upper income thresholds
at 185% FPL or above
• Almost every state dropped assets from eligibility
determination and provided “continuous eligibility”
through 60 days postpartum
• Roughly half the states had large-scale outreach
campaigns, presumptive eligibility, and shortened
forms
• Vast majority of states provided “enhanced prenatal
care” for pregnant women
THE URBAN INSTITUTE

March of Dimes Highlights:
State Enrollment Strategies
51*
50 44
36*
Number of States
40
30*
30
20 14
10
0
No Assets
Continuous
Eligibity at
Presumptive
Eligibility
Expedited
Eligibility
185% or
Eligibility
Higher
Test
*State total is higher than in 1991.
THE URBAN INSTITUTE

Number of States
0
10
20
30
40
50
Shortened
Application
25
Form
THE URBAN INSTITUTE
Self-
Declaration
8*
of Income
Mail-in
*State total is higher than in 1991.
Application
22*
Outstationed
Eligibility
Workers
35*
Online
Application
Availability
19*
Online
March of Dimes Highlights:
Application
Submission
14*
State Enrollment Strategies (cont.)

Number of States
0
10
20
30
40
50
Dedicated
Medicaid
13
Funding
THE URBAN INSTITUTE
Media
Campaigns
10
Community-
Based
22
Outreach
Targeted
Outreach
18
Incentive
Programs
19
Print
Materials
26
Multiple
State Outreach Strategies
Languages
30
March of Dimes Highlights:
Hotline
36

Number of States
0
10
20
30
40
50
Targeted
Case
32
Management
Prenatal Risk
THE URBAN INSTITUTE
Assessment
35
Preconception
Counseling
19
Nutrition
Counseling
27
Psycho-social
Counseling
30
Health
Education
28
Smoking
Cessation
32
Home Visiting
March of Dimes Highlights:
30
Substance
State Enhanced Prenatal Benefits
Abuse
32
Treatment

States Receiving Telephone
Follow-Up
Selected for Follow-Up
THE URBAN INSTITUTE

Examples of Innovative Practices
• Online application submission in 14 states
• Premium assistance in NM
• Community health workers/Home visitors
in NY
• Coordination between Family Planning
Waivers and Medicaid Pregnancy Coverage
THE URBAN INSTITUTE

Next Steps:
• Select four states for case studies
• Conduct multi-day site visits to obtain
detailed information on “best practices”
• Report on 50-state results and 4 case
studies, Spring 2008
THE URBAN INSTITUTE

Conclusions
Preliminary results suggest:
• States continue to place high priority on pregnant
women
• Tremendous variation across states
• Enrollment simplification has advanced since early-
1990s
• Outreach appears to have been scaled back
• Enhanced prenatal care benefits have also been
scaled back
• Considerable room for improvement remains
THE URBAN INSTITUTE