Background: Studies indicate that women who are uninsured before and during the first trimester of pregnancy are more likely to delay initiating prenatal care than women with first trimester coverage. Concerns have been raised that despite eligibility expansions and streamlined applications, many eligible pregnant women may not obtain Medi-Cal in a timely manner. This study examined barriers to timely enrollment among eligible women. Methods: Data were from the 1999 Maternal and Infant Health Assessment (MIHA), a statewide-representative mail/telephone survey of 3,483 mothers with live births in California, 1999. The study sample includes 647 low-income women who were uninsured before pregnancy and remained uninsured or obtained Medi-Cal while pregnant. Prevalence of maternal characteristics and enrollment barriers were calculated overall and by timeliness of enrollment. Multivariate models were used to analyze the independent contribution of each barrier to untimely enrollment. Results: Over one-third of women enrolling in Medi-Cal during pregnancy enrolled after the first trimester; one-third of these women tried to enroll during the first trimester. Perceiving Medi-Cal personnel as unhelpful appeared strongly associated with untimely enrollment, even after controlling for multiple characteristics. Related barriers that were nearly significant included: difficulty completing the application, making telephone contact, and not knowing how to apply. The first was significant for immigrants. Lag times between first attempting to obtain Medi-Cal and enrollment suggest presumptive eligibility is not working optimally. Conclusion: Enhanced training of Medi-Cal workers, further simplifying the application process, and expanded provider recruitment and public education on presumptive eligibility are recommended.
Learning Objectives: 1.Recognize the continuing problem of untimely Medicaid enrollment during pregnancy. 2. Identify potential barriers to timely Medicaid enrollment during pregnancy. 3.Develop an assessment plan to identify relevant barriers in a target population.
Keywords: Medicaid, Access
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.