Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention
Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.
We would like to thank Ellen Badley, Sandra Bannerman, Colin Chew, Richard Frank, Heather Fukushima, Steven Hoang, Amanda Jackson, Michelle Miles, Eric Neuhauser, Jenn Rico, and other staff at the California Department of Public Health (CDPH) for their help in accessing restricted California birth records, Chris Crettol, Betty Henderson-Sparks, Jasmine Neeley, and other staff at the California Department of Health Care Access and Information for help in accessing hospital discharge data, and Victoria McCoy-Cosentino at NYU for help with data use agreements. We would also like to thank Gloria Aldana, Ashley Austin, Casey Blalock, Scott Boggess, Clint Carter, Melissa Chiu, Diane Cronkite, Denise Flanagan-Doyle, Adam Galemore, Katie Genadek, Katlyn King, Shawn Klimek, Shirley Liu, Kathryn Mcnamara, Bonnie Moore, John Sullivan and other staff at Census, as well as Robert Goerge and Leah Gjertson at Chapin Hall for their help with the linkages to Census data. We are grateful for invaluable guidance received from Priya Batra and for very helpful feedback from Michel Boudreaux, Richard Frank, Hilary Hoynes, Doug Miller, Heather Royer, Adam Schickedanz, Dan Schmierer, Erin Strumpf, Andrea Velasquez, as well as comments received at the ASSA meetings, APPAM, American University School of Public Affairs, BU/Harvard/MIT Health Economics seminar, Columbia Population Research Center, Cornell University Health Economics, iHEA Early Career Researcher Pre-Congress Session, NYU, Ohio State University, Pontificia Universidad Católica de Chile, Southern Economic Association, UC Berkeley, UCLA, UC Santa Barbara, University of Maryland SPH, University of Michigan's Population Studies Center, University of New Hampshire, University of Wisconsin-Madison's Center for Demography and Ecology, UVA Batten, U.S. Census Bureau's Center for Economic Studies, and the Yale School of Public Health. We would like to thank Zoey Chopra for excellent research assistance. This research was supported by the National Institute on Aging under R01-AG059731 and by the Laura and John Arnold Foundation under their initiative to use linked data to advance evidence-based policymaking. Laura Wherry also gratefully acknowledges non-financial support from the California Center for Population Research at UCLA, which receives core support (R24-HD041022) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This research was conducted as a part of the U.S. Census Bureau's Evidence Building Project Series. The Census Bureau has reviewed this data product to ensure appropriate access, use, and disclosure avoidance protection of the confidential source data used to produce this product (Data Management System (DMS) number: P-7523114, Disclosure Review Board (DRB) approval numbers: CBDRB-FY19-532, CBDRB-FY20-045, CBDRB-FY20-183, CBDRB-FY22-CES018-007, and CBDRB-FY22-CES018-015). Any analyses, interpretations, or conclusions expressed herein are those of the authors and do not necessarily represent the views of the U.S. Census Bureau or the California Departments of Public Health or Health Care Access and Information. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.