Association for Public Policy Analysis & Management

Although the link between the fetal environment and later life health and achievement is well- established, 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 the adult health and health care utilization 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, with suggestive evidence of lower body mass indices and lower incidence of chronic illnesses. Using administrative data on hospital discharges, we find that cohorts who gained in utero Medicaid eligibility have 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 find effects of public eligibility in other periods of childhood on hospitalizations later in life, but these effects are small. Our results indicate that expanding Medicaid prenatal coverage had long-term benefits for the health of the next generation.