National Medicaid expansions in the 1980s that resulted in medical care being made available to more low-income pregnant mothers affected health outcomes for later generations, a substantial return on government investment, according to a working paper from the University of California, Davis, Center for Poverty Research.

“We find strong evidence that the health benefits associated with treated generations’ in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight,” the authors state. The study also found that there were fewer pre-term births in the families that received Medicaid benefits. These infant health measures are known to be affected by maternal health outcomes. They are also predictive of later life health and economic outcomes.

The paper, “Multi-generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation’s Health,” is one of several that will be presented today, Nov. 17, at a conference at UC Davis. The authors will present the paper at 10:30 a.m. at the Student Community Center. The meeting, titled “The Unintended Effects of the Safety Net” will feature scholars presenting papers and leading discussions on a number of safety-net programs. It is presented by the Center for Poverty Research and the Institute for Social Sciences at UC Davis.

“What this shows is that the benefits of improving low income families’ access to prenatal care not only affect the health of current generations of children but spillover onto the next generation of children as well,” said Marianne Page, a co-author of the study and director of the UC Davis Center for Poverty Research. Other authors are Chloe East, University of Colorado, Denver; Sarah Miller, University of Michigan; and Laura Wherry, UCLA.

The authors said they are the first to investigate whether the effects of a large-scale, positive, U.S. health intervention persist to later generations.

The researchers used publicly available statistics from 1994 to 2015 to analyze health outcomes among infants whose mothers were born between 1979 and 1986, when the increases in prenatal Medicaid occurred.

The additional coverage provided to pregnant women and their babies under the Medicaid expansions in the 1980s and 1990s represents the single largest effort the federal government has ever made to improve birth outcomes, the authors wrote.

Before the 1980s, Medicaid, a joint-federal state program (known as Medi-Cal in California) was more limited. The program was primarily available for pregnant women and nondisabled children who received cash welfare under the Aid to Families with Dependent Children Program, or AFDC. While income thresholds varied state to state, one was generally required to have an income well below the federal poverty line to receive the benefits. There were also restrictions that primarily restricted eligibility to single parents, so that first births were rarely covered.

The paper was supported by funding from the National Science Foundation, the U.S. Department of Health and Human Services, and other sources. The working paper has been published by the National Bureau of Economic Research, and is being circulated for discussion and comment.