Medicaid Enrollment Policies Help Pregnant Women Quit Smoking But Have Little Impact on Adverse Birth Outcomes

Researchers at the Johns Hopkins Bloomberg School of Public Health, in a paper that appears in the June issue of Health Affairs, found that a Medicaid policy that fast-tracks applications of pregnant women contributed to a nearly 8% reduction in smoking during pregnancy but did not significantly improve preterm birth rates or low birth weights. The study is the first of its kind to examine the effects of Medicaid’s presumptive eligibility and the unborn-child option – which provides Medicaid coverage for prenatal care -- on smoking cessation and smoking-related adverse birth outcomes.   

“Although the prevalence of prenatal smoking in the United States has declined in recent decades, it is nearly twice as high among low-income women enrolled in Medicaid than it is in the U.S. population as a whole,” said Marian Jarlenski, PhD, lead author of the paper. Jarlenski conducted the research while completing her Ph.D. at the Bloomberg School. “Our research shows that Medicaid’s presumptive eligibility policy led to a nearly 8 percentage-point decrease in smoking during pregnancy, but neither policy significantly improved rates of preterm birth or babies born small for their gestational age.”

Since the late 1990s, many state Medicaid programs have provided more generous coverage of services that help pregnant women stop smoking, but the complex process of enrolling in Medicaid may be a barrier to obtaining these services. Presumptive eligibility, introduced in 1986, sought to smooth out the application process. The policy assumes that pregnant women are eligible for Medicaid when they arrive for care at participating organizations and can receive care while their Medicaid applications are still pending. The second option, the unborn-child option, allows states to consider a fetus to be a “targeted low-income child” and to provide coverage of prenatal care and delivery to low-income pregnant women even if they cannot provide the documentation of citizenship or residency that is required for eligibility in Medicaid’s pregnancy category.  

For their paper, the researchers studied 24,544 low-income women in 19 states who smoked prior to pregnancy and participated in the Pregnancy Risk Assessment Monitoring System from 2004 to 2010. The authors conclude presumptive eligibility will continue to be an important policy to promote timely prenatal care, but that additional research is needed on the effectiveness of combining smoking cessation interventions with interventions targeting other risk factors to reduce adverse birth outcomes in the population eligible for Medicaid. 

“Medicaid Enrollment Policy Increased Smoking Cessation among Pregnant Women but Had No Impact on Birth Outcomes” was written by Marian Jarlenski, PhD, MPH; Sara N. Bleich, PhD; Wendy Bennett, MD, MPH; Elizabeth Stuart, PhD; and Colleen Barry, PhD, MPP. 

Funding for the research was provided by the National Institute on Drug Abuse of the National Institutes of Health (F31DA035007). 

# # #

Media contact for Johns Hopkins Bloomberg School of Public Health's Department of Health Policy and Management: Susan Murrow at 410-955-7624 or smurrow1@jhu.edu. Media contact for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu.