Why is it SO hard to find good care when Medicaid is your insurance carrier?

Well, here’s the succinct answer provided by a recent communication from our billing service [plus extra comments and explanations from Kristin]:

“I am writing today with extremely disappointing news. Washington State Healthcare Authority (HCA, DSHS, Medicaid, ProviderOne, Apple Health) has dropped the reimbursement rates effective July 1, 2016 for birthing centers and global maternity care below the rates that were in effect 3 years ago.”

This means that Medicaid is reducing their payments for care that has already been provided and completed.

“Global maternity care is now being reimbursed at $1,992.84.”

Compare that to the global fee of $3000-4500 charged by the average Licensed Midwife and the $3500 charged by Sunrise Midwifery.  Keep in mind that each client on Medicaid also costs the midwife the billing fee of about $200-400, reducing the overall income even more.

“The facility fee reimbursement rate is $584.61.”

This means a birth center is paid ONLY $585 per birth.  The per birth cost to the birth center for just having a birth occur in the facility is over $750!  In essence, the birth center or provider must PAY to have a Medicaid birth take place at their facility.  It is unsustainable.

“This is a 3.5% decrease in reimbursement.”

What?  After the past years of MAWS working so hard to get better reimbursement for midwives, and proving our value to the system, they reduce our pay?  You mean they want us to do more care, work harder, fill out more paperwork, while they pay us less?

“Midwives are not being specifically targeted. These rates are the same in the Physician-Related Services fee schedule. You can download the current and previous fee schedules for Planned Home Births and Births in Birthing Centers or Physician Related Services at: http://www.hca.wa.gov/billers-providers/claims-and-billing/professional-rates-and-billing-guides

That link shows you how much Medicaid pays for each service.

“I’m sure you are as angry about this news as I am. Healthcare providers are being required to subsidize healthcare reform at the cost of their own businesses. Maternity care providers cannot limit the number of clients they accept with Medicaid like pediatricians, primary care physicians, and specialists as clients can qualify for pregnancy medical care retroactively.”
So your midwife, your obstetrician, your pediatrician, your family practice doctor, ALL pay to take care of you.  Can you imagine your electrician coming on their own time to replace your faulty breaker box (a very worthy and important service that will protect you and your family) and them not getting paid for it?  Of course not.  But this is exactly what our Legislature has voted for.
The “qualifying for pregnancy care retroactively” is really problematic for the provider or facility.  It means that if the client had private insurance all during pregnancy, but then gets Medicaid once the baby is born, the provider MUST REIMBURSE the client the money the client may have already paid under their previous terms of coverage because it is illegal to ask a client with Medicaid to pay for services that midwife is under contract for!
You may be wondering what you can do to fight this issue. These rates are set by Washington State Legislature.  They are trying to save money by defunding the EXACT providers who save them millions of dollars!  Why are they cutting off their noses to spite their faces?  Usually it’s because they don’t really know what’s at stake.
Granted, the budget is really out of whack and something needs to be done.  But underpaying midwives and birth centers, two groups with fabulous track records of safety AND cost-effectiveness, is NOT the answer.  The opposite is the answer.  Pay midwives and birth centers their full fees, increase the number of cheaper out-of-hospital births, decrease the number of expensive c-sections and IV lines, and reduce healthcare costs.

You need to get involved in the legislative process to make a change and get better access to care!

Our current system is unsustainable.  There will be NO providers because they cannot make a living.  People needing medical or midwifery care will not be able to get it.
  • The Midwives Association of Washington State is the first place to start for resources and information regarding lobby days and reimbursement committee participation.
  • JOIN MAWS TODAY as a supporter to help us keep the midwives and birth centers in business.
  • Call Kristin anytime to find out more.
MAWS members at Olympia

Lobby Day 2016 brought over 50 MAWS members and midwifery consumers to the capital