Impact of Prenatal Care Eligibility Restrictions on Health Outcomes: A GIS Analysis of Immigrant Composition and Provider Location

Shanti Gamper-Rabindran

The federal Personal Responsibility and Work Opportunity Reform Act of 1996 (PRWORA) ended Medicaid funding for prenatal care services for legal immigrants who entered the US after August 1996. Using confidential birth certificate data geo-coded to the census tract level between 1990-2001 in Texas, the policy impact is estimated by comparing low-income foreign-born Hispanic women, who are more likely to be affected by the Act, with US-born Hispanic women, controlling for proximity to prenatal care providers. Under the assumption that 70% of the foreign-born are legal immigrants (per the Immigration and Naturalization Service figures), PWRORA is estimated to cause about a 6% decline in the number of prenatal care visits for foreign-born women in urban Texas after the second year, and by 9%, 12% and 15% in the subsequent years. Foreign-born women living in areas with high ratios of recent immigrant experience a greater decline in visits.