Maternal and Child Health Update: States Are Using Medicaid and CHIP to Improve Health Outcomes for Mothers and Children

The 2014 Maternal and Child Health Update (MCH Update) presents data gathered by the National Governors Association Center for Best Practices (NGA Center) through a survey of states and territories (collectively referred to as states). Previous MCH Updates have focused on topics ranging from Medicaid and Children’s Health Insurance Program (CHIP) eligibility to state action related to the Affordable Care Act (ACA). The 2014 survey, however, focused on state efforts to improve the quality of care and reduce costs of providing services to maternal and child health (MCH) populations. State activities to improve birth outcomes remained a priority for governors and a focus of the MCH Update for 2014.


Medicaid and CHIP remain important sources of insurance coverage for many Americans, and for pregnant women and children in particular. One of every three children in the United States receives health care through Medicaid or CHIP coverage, and according to this year’s data, 45 percent of births are covered through those programs. That figure remained constant from 2012 to 2013, the two years for which data were reported, and is consistent with other data sources. Medicaid and CHIP cover more than 50 percent of children in families below the federal poverty level and are especially important in helping them access health care. The ACA has expanded coverage options for pregnant women and children with lower incomes, though challenges relating to continuity of care remain. For example, an individual’s eligibility for coverage through the health insurance exchanges,
Medicaid and CHIP can fluctuate.

States also have worked to improve health care outcomes for pregnant women and children and to lower the cost of care by implementing new payment models. States’ incorporation of those models into their Medicaid and CHIP coverage can have an especially large effect for maternal and child health populations because of the large percentage of births across the nation covered through those program. The 2014 MCH survey focused on quality improvement initiatives for mothers, infants, and children, especially as part of Medicaid and CHIP coverage. Some questions about previous years’ initiatives were dropped; other
questions were added regarding the prevalence of elective deliveries and tobacco use among MCH populations. Forty-two states provided information on at least some of the questions, although not all states responded to every question. For each finding, the number of states responding is noted.