The Effect of Medicaid Eligibility Expansions on Fertility

Marianne Bitler, RAND
Madeline Zavodny, Federal Reserve Bank of Atlanta

Pregnant women and children's eligibility for Medicaid was dramatically expanded during the 1980s and early 1990s with the goal of increasing women's use of prenatal care and children's access to medical care. By lowering the costs of prenatal care, delivery, and child health care, the Medicaid expansions may have increased women's fertility or changed the timing of births. This study uses natality data from 1981 to 1996 and 1995 Current Population Survey data to examine the effect of changes in states' eligibility thresholds for Medicaid on fertility behavior. We use both panel data techniques with state-level data and duration models with individual-level data. Our results suggest that the Medicaid expansions raised birth rates among some groups. They also show the importance of considering exposure by different cohorts to reform in assessing the impact of reforms on birth spacing.