# Effects of Medicaid expansions on infant health among Native Americans

> **NIH NIH R03** · STATE UNIVERSITY OF NEW YORK AT ALBANY · 2021 · $77,250

## Abstract

The effects of Medicaid expansions on Native American (NA) birth outcomes are understudied.
Since the early 1980's, there have been two periods of notable expansions in Medicaid eligibility
criteria that have been adopted by different states at varying times. In the late 1980s and 1990s,
states increased Medicaid income thresholds for pregnant women to varying degrees. In 2014
and later, under the Affordable Care Act, many states expanded Medicaid thresholds for low-
income adults. While the first period primarily may have increased pregnant women's access to
prenatal care, the later period of expansion potentially has further increased women's access to
pre-conception care. NA mothers have elevated rates of low birth weight (<2,500 gm), preterm
birth (gestation < 37 weeks), and macrosomia (birth weight > 4,500 gm). These disparities,
reflecting elevated rates of poverty and chronic disease in NA communities, are rooted in
systems of structural racism and historical trauma. Medicaid is an important source of health
insurance for NAs, covering 67% of NA births as of 2018. As such, Medicaid expansions have
the potential to substantially improve NA maternal and infant health. However, NA women also
may face barriers to accessing care and to having that care translate into improved infant
health. In particular, heterogeneity in communities' economic and health care resources, as well
as proximity to Indian Health Services, may influence how Medicaid impacts NA birth outcomes.
The proposed work draws on national-level microdata from U.S. birth certificates and employs
multiple measures of birth outcomes (i.e., birthweight, gestational age, fetal growth rates, and
APGAR scores), capturing distinct aspects of fetal development and infant health. The
American Community Survey is also used to assess trends in insurance coverage. Identifying
plausibly exogenous Medicaid expansions in two periods (1989-1997 and 2010-2018), this
project aims to: (1) Estimate the effects of Medicaid expansions on birth outcomes among NA
mothers, testing whether effects differ for NA mothers relative to mothers from other racial-
ethnic groups; (2) Evaluate whether Medicaid has differing impacts on infant health depending
on the attributes of the counties in which mothers reside; and; (3) Estimate the effects of
Medicaid on plausible mechanisms linked to birth outcomes, specifically, insurance coverage,
prenatal care, smoking and weight gain during pregnancy, and maternal health risk factors
during pregnancy. As health at birth shapes wellbeing and economic outcomes across the life
course, a deeper understanding of how Medicaid influences NA maternal and infant health is
likely critical to longer-term goals of improving health and economic conditions for future
generations of NAs.

## Key facts

- **NIH application ID:** 10191658
- **Project number:** 1R03HD104920-01
- **Recipient organization:** STATE UNIVERSITY OF NEW YORK AT ALBANY
- **Principal Investigator:** PINKA CHATTERJI
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $77,250
- **Award type:** 1
- **Project period:** 2021-05-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10191658

## Citation

> US National Institutes of Health, RePORTER application 10191658, Effects of Medicaid expansions on infant health among Native Americans (1R03HD104920-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10191658. Licensed CC0.

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