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Barriers to enrollment in Medi-Cal lead to inadequate prenatal care for some disadvantaged women in California

About 4 percent of U.S. women who give birth each year either do not get prenatal care until the third trimester of pregnancy or have no prenatal care. This lack of care precludes timely diagnosis and management of maternal and fetal problems that can be more common among medically and sociodemographically disadvantaged women.

Despite expansion of Medi-Cal (California's Medicaid program) eligibility for maternity care coverage to 200 percent of the Federal poverty level (up to $29,600 for a family of four in 1994), low-income women (incomes less than or equal to 200 percent of poverty) still were more likely than other women to have late or no prenatal care in California, according to findings from a State-wide, representative survey of postpartum women. The study was supported in part by the Agency for Healthcare Research and Quality (HS07910) and conducted about 5 years after the income-eligibility expansions occurred. Based on data from postpartum interviews, the researchers identified characteristics and major risk factors for late or no prenatal care among 6,364 low-income women.

Women in absolute poverty (incomes up to $14,800 for a family of four in 1994) were nearly nine times as likely to get no care as women with incomes between 101-200 percent of the Federal poverty level. Women who had more than one child, unmarried women, and women whose pregnancies were unplanned were three times more likely to have no prenatal care. Among women with no care, 42 percent were uninsured, despite being income-eligible for Medi-Cal maternity care coverage. Over 40 percent of the uninsured women who lacked care had applied for Medi-Cal maternity care coverage during pregnancy but either were denied coverage or did not complete their application. Race and education level did not seem to influence prenatal care initiation, and problems with child care and transportation were not significant barriers to care.

The results strongly suggest that barriers and/or missed opportunities need to be addressed within the Medi-Cal application process itself, according to Paula Braveman, M.D., M.P.H., of the University of California, San Francisco, and her colleagues. In addition to eliminating barriers to prenatal coverage, policies to reduce late/no care should focus on prepregnancy factors such as family planning and poverty reduction, rather than on logistical barriers during pregnancy.

See "Risk factors for late or no prenatal care following Medicaid expansions in California," by Melissa Nothnagle, M.D., Kristen Marchi, M.P.H., Susan Egerter, Ph.D., and Dr. Braveman, in Maternal and Child Health Journal 4(4), pp. 251-259, 2000.

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