If you’re involved in the public health world in Ohio, you’ve certainly heard about the problems the state has with infant mortality, with the state ranking in the top ten states for infant death rate according to the CDC. At the same time that Ohio struggles with infant mortality, federal regulators have made news by authorizing states to block grant a portion of Medicaid dollars, potentially reducing access to Medicaid coverage by low-income adults. State lawmakers have been skeptical of adopting such a plan at this point, though the legislature does have a track record of restricting access to the program in the past.
It should be noted that federal officials have stated pregnant women will not be impacted by the block-grant scheme. That being said, limiting access to Medicaid for non-pregnant women could make it more difficult for a pregnant woman to understand when she is eligible. Also, there is some evidence that states with Medicaid expansion have shown progress on infant mortality despite pregnant women not being a part of the expansion population, suggesting that either the policy is making it easier for pregnant women to care for their children or that some other factor is at work in expansion states that is leading to reductions in infant mortality rates.
This study is one of the latest in a long list of studies establishing a link between Medicaid coverage and infant mortality. While experimental evidence of Medicaid’s impact on physical health is famously lacking, quasiexperimental evidence of the nation’s largest safety net program’s impact on infant mortality has been mounting for the past twenty-five years. One study suggested higher Medicaid payments have significant impacts on infant mortality rates while another on Medicaid eligibility suggested just being eligible for Medicaid had an impact on child mortality. A later study found higher Medicaid payments could reduce incidence of low birthweight, a significant risk factor for infant mortality. Another study found that expansions of Medicaid access can lead to lower fetal death rates and a more recent study found access to care can reduce racial gaps in infant mortality.
The fact that most of these studies deal specifically with pregnant women as a population suggests that exempting pregnant women from policies that could restrict access could save lives for children down the road. But restrictions for other populations could have spillover effects as well as women find it harder to identify when they are eligible. Care should be taken to craft Medicaid policy that lines up with state public health goals because, as this body of evidence shows, access to care can impact the lives of infants.