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Timing of Medicaid Enrollment During Pregnancy and Associated Infant Outcomes

Year: 2026

Type: article

Abstract: OBJECTIVE: To describe the timing of Medicaid enrollment during pregnancy among Medicaid-insured women in Texas, examine patterns of health care utilization following enrollment, and evaluate associations between enrollment timing and infant outcomes. METHODS: Retrospective cohort study of 913,229 deliveries to women aged 15-44 years enrolled in Texas Medicaid between January 1, 2010, and December 31, 2014. Women were classified into five mutually exclusive groups based on timing of first Medicaid enrollment: before conception, first, second, or third trimester, or delivery hospitalization. We evaluated associations between enrollment timing and cesarean delivery, preterm birth, small-for-gestational-age (SGA), and neonatal mortality using Poisson regression with robust standard errors. RESULTS: Overall, 26.4% (n = 238,689) of women enrolled in Medicaid before conception, 40.0% (n = 364,905) during the first trimester, 14.3% (n = 130,568) during the second trimester, 6.1% (n = 56,090) during the third trimester, and 13.5% (n = 122,977) at delivery. Later enrollment was more common among Hispanic and foreign-born women and among those with a lower mean obstetric comorbidity index. Most women had their first Medicaid-covered health care encounter in the same trimester as enrollment, primarily in ambulatory care settings. In adjusted analyses, enrollment before conception was associated with a higher risk of preterm birth (aRR 1.17; 95% CI, 1.15-1.18) relative to first-trimester enrollment. Second- and third-trimester enrollment were associated with higher risks of SGA (aRR 1.15 [95% CI, 1.12-1.18] and 1.18 [95% CI, 1.13-1.22], respectively). CONCLUSION: Medicaid enrollment timing varied across demographic groups and was associated with differences in health care utilization and selected infant outcomes. Improving maternal and infant health may require not only timely coverage but also efforts to address structural barriers to Medicaid enrollment and prenatal care access.

Source: Academic Pediatrics

DOI: 10.1016/j.acap.2026.103419

Authors: Patience Toyin-Thomas, Christopher G. Leggett, David C. Goodman, JoAnna K. Leyenaar

Institutions: Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth–Hitchcock Medical Center, Children's Hospital at Dartmouth Hitchcock

Language: English

Topic: Maternal and Neonatal Healthcare

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $3,400