The Long-Term Effects of Early Life Medicaid Coverage*

Although the link between the fetal environment and later life health and achievement is wellestablished, few studies have evaluated the extent to which public policies aimed at improving fetal health can generate benefits that persist into adulthood. In this study, we evaluate how a rapid expansion of prenatal and child health insurance through the Medicaid program affected adult outcomes of individuals born between 1979 and 1993 who gained access to coverage in utero and as children. We find that those whose mothers gained eligibility for prenatal coverage under Medicaid have lower rates of obesity as adults and fewer hospitalizations related to endocrine, nutritional and metabolic diseases, and immunity disorders as adults, with particularly pronounced reductions in visits associated with diabetes and obesity. We also find that the prenatal expansions improved educational and economic outcomes for affected cohorts. Cohorts who gained Medicaid eligibility in utero have higher high school graduation rates and we find evidence suggesting that they have higher incomes in adulthood. We find effects of public eligibility in other periods of childhood on self-reported health, hospitalizations, and income later in life, but these effects are smaller in magnitude. Our results indicate that expanding Medicaid prenatal coverage had sizeable long-term benefits for the next generation. * This work was supported by the Robert Wood Johnson Foundation’s Health Policy Scholars and Health & Society Scholars Programs at the University of Michigan, Ann Arbor. In addition, Laura Wherry benefited from facilities and resources provided by the California Center for Population Research at UCLA (CCPR), which receives core support (R24-HD041022) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). We would like to thank Gabriella Conti, Andrew Goodman-Bacon, Jim House, Genevieve Kenney, Bhashkar Mazumder, Lindsay Sabik, Brendan Saloner, Daniel Schmierer, and Ben Sommers for helpful conversations and participants at presentations at AcademyHealth, American Society of Health Economics, NBER Cohort Studies, Population Association of America, Robert Wood Johnson Foundation Health and Society Scholars meeting, UCLA, University of Michigan, and the University of Illinois at Chicago, as well as Pat Barnes, Clint Carter, Frank Limehouse, and John Sullivan for their assistance in accessing the restricted data used in this project at the California, Chicago and Michigan Census Research Data Centers.