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Objectives. Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. The study evaluated the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. Methods. The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. Results. The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states Washington's low-birthweight rate decreased (7.1% to 6.4%, P=12), while Colorado's rate increased slightly (10.4% to 10.6%, P=.74). Washington's improvement was largely due to decrease in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P=.01, for adults, 22.5% to 11.5%, P=.03, for teenagers), especially those with preexisting medical conditions. Conclusions. A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women. [ABSTRACT FROM AUTHOR]