State factors and maternal health among immigrants

/ABSTRACT Health before pregnancy and between pregnancies (preconception) is inextricably linked to health during pregnancy as well as delivery and infant health outcomes. Insurance coverage increases access to preconception and postpartum health services yet some immigrants are not eligible for Medicaid before, during and after pregnancy. Some states use longstanding alternative federal funding mechanisms to provide public insurance coverage during pregnancy to this group (referred to as “non-qualified (NQ) immigrants”). Historically, public insurance coverage for non-qualified immigrants outside of pregnancy was extremely rare in the US. However, states have recently made major strides in expanding public health insurance eligibility for non-qualified immigrants outside of pregnancy through two new policy pathways. In this project, we will examine maternal health outcomes among non-qualified immigrants and examine the impact of recent state policies that expanded public insurance to non-qualified immigrants before and after pregnancy on perinatal healthcare, and maternal and infant health. Aim 1: We will use recently modernized national Medicaid claims data 2019-2022 to examine differences in maternal health outcomes for enrollees covered by Emergency Medicaid compared to full-scope Medicaid during pregnancy. We will compare rates of severe maternal morbidity and potentially avoidable delivery complications. Aim 2. We will examine the impact of California’s 2020 policy to extend public insurance eligibility to all NQ immigrant adults between ages 19 and 25 on prenatal healthcare and pregnancy outcomes. We will use novel linked California Medicaid claims and birth certificate data and a difference-in-differences approach comparing NQ immigrants who were eligible and ineligible for preconception Medicaid on the basis of their age to estimate the impact of this policy on timely prenatal care use, pregnancy complications, and birth outcomes. Aim 3. We will examine the impact of New York’s 2023 policy to offer extended pregnancy Medicaid coverage from 60 days to one year postpartum to NQ immigrants. We will use a novel linked dataset combining New York Medicaid claims with the universe of state hospital records, as well as clinical records from the state’s safety net healthcare providers. Using a difference-in-differences approach, we will compare changes in postpartum healthcare use and health outcomes between NQ immigrants and enrollees covered by full-scope pregnancy Medicaid to estimate policy impact. The findings from this project will provide new information on maternal health outcomes among NQ immigrants, as well as timely and actionable evidence about the impact of extensions of public insurance in the preconception and postpartum period to NQ immigrants on pregnancy and postpartum health. Project Number: 5R01HD115930-02 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Maria Steenland | Institution: UNIV OF MARYLAND, COLLEGE PARK, COLLEGE PARK, MD | Award Amount: $490,762 | Activity Code: R01 | Study Section: Social Sciences and Population Studies A Study Section[SSPA] View on NIH RePORTER: https://reporter.nih.gov/project-details/5R01HD11593002