Continuous Medicaid Eligibility During COVID-19 and Fertility Among Low-Income Women Without Dependent Children: United States, 2016‒2023.

Objectives. To evaluate the impact of continuous Medicaid eligibility under the Families First Coronavirus Response Act on fertility among lower-income women without dependent children. Methods. Using 2016-2023 data from the American Community Survey (n = 100 434), we applied a difference-in-differences approach to compare trends in fertility from prepolicy (2016-2019) to postpolicy (2021-2023) among low-income women of reproductive age without dependent children, in US states that expanded Medicaid under the Affordable Care Act ("exposed" states) and those that did not ("unexposed" states). We performed subgroup analyses by citizenship, marital status, and age. Results. Continuous Medicaid eligibility was not associated with a change in prevalence of giving birth (-0.1-percentage-point decrease; 95% confidence interval [CI] = -1.1, 0.8) among low-income women without dependent children. Null results were consistent across marital status and citizenship, but a significant decrease was found among those aged 30 to 34 years (-2.7 percentage points; 95% CI = -5.1, -0.2; -33% from a baseline prevalence of 8.1%). Conclusions. Continuous Medicaid eligibility during the COVID-19 public health emergency had minimal to no impact on fertility among low-income women without dependent children; however, there was a large decrease among those aged 30 to 34 years. (Am J Public Health. Published online ahead of print September 24, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308748).