Giving birth on Medicaid in Michigan...?

[Bosky]

I would love to have a homebirth.  But my understanding is that Michigan Medicaid will not cover out-of-hospital births, at all.  I've thought about just sucking up the cost (I know there are some very kind homebirth midwives out there who take payments :).  But, it is a lot of money to spend, money we don't really have, when the state would pick up the tab for the hospital bill.  Ridiculous.

I guess I'm just wondering if there are any options I'm missing?  Or anyone's thoughts on the subject?  Right now I'm looking at delivering in U of M's birth center with one of their midwives.  I have an appointment set up but not for a couple of weeks yet.  Anyone have opinions on them?  My understanding is they're a bit better than average for keeping c-sections low, keeping mom with baby and so on.  But honestly, the thought of giving birth in any hospital, unless absolutely necessary, is a little bothersome to me.  I know I don't feel comfortable in hospitals, or with strangers in general, much less when doing something as intimate as giving birth.  So I keep reconsidering paying out-of-pocket for a homebirth... sigh.

I lived in Vermont for the last couple years where this would not have been an issue... they cover homebirths, and birthing centers, and other wonderful things.  Go Vermont!  Unfortunately I could not give birth there because, as much trouble as it would have saved me, I had to go home to Michigan -- and my mom -- to get brave enough to try this pregnancy thing :)

Anyway, I've been browsing information on these forums now and then, and you all seem very helpful, so I thought I'd at least present my dilemma and see if anyone has any thoughts!

Edit: Oh, and for the record, I live near Pinckney, about halfway between Ann Arbor and Lansing, if anyone knows of options in the area.  Thanks!

[Daisie125]

The only way Medicaid will cover an OOH birth in Michigan is if it's with a homebirth CNM who accepts Medicaid.

[Defenestrator]

I have seen some very nice births at UofM with the midwives.  The new hospital is supposed to have expanded waterbirth facilities as well.  Your postpartum experience will not be as attentive as it would have been with a homebirth midwife, but you can draw upon other resources to make that better.  I would highly recommend a doula to help you labor longer at home.  If you can't afford one, then you can access Doulas Care, which provides volunteer doulas for low-income families.  Good luck!

[nattysmum07]

I am currently in the same situation as you.  I was just about to come here and post for some Midwife recommendations.  I'm looking for someone who will accept payments and will take me on after 1 vaginal delivery and 2 previous (low lying transverse incisions ) c/s's.  The c/s's were for breech babies.  I am over 2yrs out from my last c/s.

I am looking at U of M hossy as well but need to find a midwife as I am in the middle of switching plan's. 

GL mama I will let you know what I find!  You could call Gretchen (ican of Ann Arbor) at 517-745-7297 I talked to her for about 1/2 hour she had some good advice as well.  Esp considering you haven't had any c/s's!

[amberbirthdoula]

Hi ladies, 

I really like the U of M midwives as well, but I also recommend a doula. I'm a volunteer with Doulas Care and like Stacia said they offer free & reduced rate services to women in Southeast Michigan. I am also personally offering free services for private clients right now and I'd be happy to chat with anyone in the area about my doula services/other resources for birth on a budget in the area. 

[la mamita]

nak

pat kramer might be a good choice, i think shes a cnm and woud be covered.
or new moon offers a sliding scale & maybe other midwives do too. i personally would pay out of pocket for a hb instead of trying to save 2000 and going to the hospital. that is your call tho.

[Daviidoo5]

Hi! I was in the exact same boat as you! I hate the hospital, I'm not a high risk..and I plain and simple do not want to be in a hospital!!

I looked into a birth center (Greenhouse -its in Lansing) and it runs about 3000 dollars. BUT that covers prenatal care, the birth and postpartum. How it works is they don't bill insurance. They give you the bill and you work it out with insurance. They told me that clients always have problems with medicaid.

I couldn't find any birth centers nearby that I liked/took medicaid at all..

So I started looking into homebirth midwives (CPMs)

I'm a student. I don't have a partner (he was abusive) and I'm currently unemployed. Money is extremely tight. However..I did recognize that this may be a once in lifetime opportunity for me. And even if I have subsequent children..it will probably only happen maybe once or twice more. Its a very special thing..

Anyways..thats when I found Cathy and Ashley Dowd. They're based out of Midland MI - And do travel. They're a mom and daughter-in-law team..you may only get one or the other for your birth but you'll probably meet both. They're both extremely friendly, professional and they've done all of my prenatal care. I feel extremely comfortable with them and trust them more than any medical birth professional I've come across.

Their overall fee for all prental, birth and postpartum is 1500. Which is a deal! And they're more than willing to work with you on payments. They have worked with me soooo well. And one thing I've appreciated about them is they aren't pushy about money at all.

Early in my preganncy I had to visit the ER (I was fine!) but...the ER nurses wouldn't even touch me without first having my insurance information...nice..

I think they both love their work as midwives..

If you're interested just google 'New life Midwifery services'

Not sure if this link will work but I'll try!

http://birthpartners.com/ls-1-26-24-1733-New_Life_Midwifery-Midwives,_Will_Travel-in-Michigan-United_States.aspx 

[mothercat]

Pat is an RN and a midwife, but she is not a CNM.

MIchigan MCD and the MCD managed care plans  will be required to pay a birth center facility service fee, the same as they would pay the hospital facility fee. It was part of the health care reform act that Obama signed 3/23/10, effective 7/1/10. Birth centers need to be participating with MCD to be paid.  CNMs are the only class of midwives currently licensed in MI, so are the only ones who can be reimbursed by MCD (and the MCPs). They are paid for the care they provide and federal regulations specify that as long as the midwife is practicing in settings she is allowed to by her scope of practice (home, clinic, hospital) then she must be paid for the services she provides in those settings. MI scope of practice for CNMs does not limit where they can practice thus all settings are legal.

[Susan Jenkins]

Federal law requires all state Medicaid plans to cover nurse-midwives in all settings, as well as all licensed birth centers as well as licensed midwives who provide services in birth centers.  It is not that the birth centers in Michigan won't accept Medicaid.  Rather, the problem in Michigan is that the state Medicaid agency (1) will not cover CNMs for out of hospital births even though it is within their legal scope of practice; (2) will not cover CPMs or other midwives because they are not licensed in the state and Medicaid only has to pay licensed providers, and (3) will not pay birth centers for the same reason, because there is no licensing law for birth centers.  The only way any of these situations will change is if Michigan law is changed to (1) make it specific that CNMs may provide out-of-hospital birth services within their license (2) CPMs become licensed (a group of consumers and midwives is working on this and you are urged to join them to lobby the state legislature), and (3) the law is changed so that birth centers can get licensed, as they are in 40 other states, and that both CNMs and CPMs can practice in birth centers.  I know about this because I work for the American Association of Birth Centers.  We got federal law changed in 2010 to get birth centers and midwives who work in birth centers covered, but the feds will only enforce this requirement if the birth center or midwife is licensed.  CNMs are licensed and are already mandated by federal law but the Medicaid agency refuses to obey the federal rules.

The answer?  Citizen action to let your legislators know that women and families in Michigan want access to midwives and birth centers and want that care to be covered by Medicaid and other insurance.  Insurance plans are unlikely to pay for unlicensed providers.  State by state, people are getting their laws changed.  Wisconsin just legalized CPMs, the midwives who specialize in out-of-hospital birth, in 2006.  You could do it too.  Google to find out about it and join the citizen group working for legal status for CPMs -- and tell them you want to work for licensed birth centers also.  Google The Big Push for Midwives Campaign and the American Association of Birth Centers, to learn more about citizen action for birth access and justice.