108-113 Joyce

Family Planning Perspectives Through the mid-1980s, Medicaid eligibility requirements included very low income thresholds established by the individual states. Between 1987 and 1991, eligibility standards for poor and near-poor pregnant women were expanded dramatically. The 1986 Omnibus Budget and Reconciliation Act (OBRA) permitted states to extend eligibility (and receive reimbursement for services provided) to individuals with an income up to 100% of the federal poverty level. The 1987 OBRA permitted states to raise the threshold to 185% of the poverty level, and the 1989 OBRA mandated increases to 133% of poverty.1 As a result, the proportion of births financed by Medicaid rose from 15% in 1985 to 32% in 19912 and to 39% in 1994.3 Furthermore, the number of children enrolled in Medicaid increased by 47% between 1989 and 1992.4 Coincident with these eligibility expansions, the U.S. fertility rate rose by 7%, from a recent trough of 65.4 births per 1,000 women aged 15–44 in 1986 to 69.6 per 1,000 in 1991. Over roughly the same Is Medicaid Pronatalist? The Effect of Eligibility Expansions on Abortions and Births