Why is Medicaid completely unsustainable?
Contact your legislators
Unfortunately, we are still unable to accept Medicaid HMO and do not foresee changing this policy, regardless of the health insurance debate currently raging. In short, the Medicaid payments to the provider do not even cover the cost of providing care, let alone any profit, and Medicaid paperwork is outrageous. In reality, this translates to the provider being unable to pay her own mortgage and bills, buy necessary supplies and medications for her clients, and expand her practice to care for more pregnant people.
Clearly, this situation is unsustainable, decreases access to care, and burns out the providers.
We recognize that our policy reduces access to midwifery care in some cases. Unfortunately, access to midwifery care is even more limited when midwives cannot practice due to excessive overhead costs and time associated with insurance billing! The amount that your Medicaid HMO pays to the midwife is always much less than the cost of care, in our case, approximately $1800 (out of the $3500 midwifery fee) is paid for a course of care, then we have to pay $200 to the biller. A small practice based on low-volume of clients with high-time involvement cannot survive on that rate.
There is more to the story. The state pays each HMO to supervise the insurance care for each pregnant mother. This amount is several times the cost of midwifery care package fees. But the full midwifery fee is NEVER paid by that HMO. Where do those thousands of dollars go?? Not to the providers. Not to more maternity care for more mothers.
This problem exists for birth centers also. Up to July 2017, after successful lobbying by MAWS and birth center owners, the Medicaid payments for birth in a birth center did NOT even cover the operating costs. Not only does the birth center not make any money, it actually ends up paying for the birth to occur there! This is not sustainable and will reduce access to care.
If you are upset by the lack of access to midwifery or maternity care, please contact DSHS, your HMO and your legislators. Tell them this situation is unacceptable. Tell your friends and family to tell them this situation is unacceptable. Have them call me to find out why YOU do not have the benefit of midwifery care via Medicaid!
The DOH has studied the cost benefits of midwifery care by licensed midwives…and it is significant, millions of dollars annually. If more midwives provided care more often to more mothers, the state would save huge amounts of money.