Mamas on Bedrest: Midwives for Medicaid in Texas???August 29th, 2012
Yesterday, August 28, 2012, I attended a public hearing to witness testimony regarding a proposed ruling concerning certified nurse midwives and licensed professional midwives: whether or not they will be able to attend the births of women on Texas Medicaid and be reimbursed for their services.
For those of you who don’t know, this is HUGE!!! Texas has very high rates of maternal and infant mortality and those rates are disproportionately highest amongst women of color and low income women of color in particular. In an effort to try and reverse these statistics, Mamas of Color Rising, a grassroots coalition of women of color, has come formed to address issues of health, welfare and economics in women of color. For more than a year, Mamas of Color Rising-in partnership with Texans for Midwifery-has worked on what they call a Birth Justice Campaign to petition the Texas Department of Health and Human Services to change the rules regarding the practice of midwives in Texas. In their letter to the department of HHSC, Mamas of Color Rising makes the following statements regarding birth equality and birth justice,
Through this campaign we aim to make options like midwifery care, homebirth, and birth companion (doula) support, options which currently are most available to those who have the resources to pay for them, equally accessible to poor women of color in our community. We believe that equity in birthing options is both a matter of social justice and empowerment for birthing women, such access also leads to improved pre-natal, post-natal, and maternal outcomes for mothers and babies that can have long-lasting positives effects.
The coalition collected signatures for a petition that culminated in a letter to Texas HHSC asking that Certified Nurse Midwives and Licensed Professional Midwives not only be able to attend births of low income women, but to also be reimbursed by Medicaid. The terms and provisions for practice and reimbursement are summarized here. In summary, here is what the proposed ruling entails:
Certified Nurse Midwives (CNM)
- Must be a licensed CNM and certified by the American College of Nurse Midwives
- Must be enrolled and able to participate in the State Medicaid Program
- Must have a physician or group participating in the State Medicaid Program to whom she can refer and/or consult in the event of medical complication
- If the supporting physician or group is not a State Medicaid Participant, the Midwife must apprise her client that she will be responsible for any additional charges incurred.
- If the Midwife changes physician association, she must notify HHSC in writing of her new physician association within 10 business days.
Licensed Midwives (LM)
- The LM must be licensed and approved by the Texas Midwifery Board
- The LM must be enrolled and approved for participation by the Texas Medicaid Program
- She practices within the rules and protocols set forth by the Texas Midwifery Board
- She provides services within a freestanding birthing facility approved by and able to participate in Texas Medicaid.
There were two areas of contention.
- The proposed rule is proposing to reimburse Midwives at 70% of what physicians are reimbursed
- Licensed midwives would have to retain a physician to serve as backup for all Medicaid patients
The hearing was a culmination of all that work, and an opportunity for Texas Medicaid officials to hear testimony from those supporting the new rules. I was heartily impressed by the testimony. While some hearings are screaming matches between opposing parties, this hearing was well organized, well conducted and from what I saw, all parties conducted themselves with poise, grace and consideration of opposing viewpoints. In watching the proceedings, I do believe that the representatives for the department of HHSC were also impressed by the testimonies and the overall conduct of the participants. While the proposed rules change looks to be on track for passage, proponents and activists are concerned about the 2 aforementioned provisions; the decreased reimbursement on an already substandard payment will deter Midwives from attending Medicaid patients and the requirement to have physician back up-nearly impossible in today’s obstetrical climate-will render the ruling ineffective despite passage.
The officials at the Texas HHSC are expected to receive additional written testimony and begin the decision making process by the end of the week. While a decision could be made as early as next week, most at the hearing think that the officials will not make a final decision on the rules changes for about 30 days.