Medicaid and Homebirth in MD, how does this work?

[secondimpression]

I'm already on Medicaid through a "Rare and Expensive Case" exception. They arbitrarily signed me up for an MCO without giving me any information or choice first (I'm seriously P.O.ed about that since the MCO they choose for me covers NONE of my expensive medical care and can't seem to get ahold of a case manager). Besides that boatload of awesome fun, I'm now pregnant and wondering how exactly you go about this homebirth shebang through Medicaid. Which MCO's cover it/are there any "tricks"/key words to assuring coverage? What, if anything, is not covered/do you have to pay out of pocket (birth supplies/assistant fees)? I know Evelyn works with Medicaid but I literally know nothing beyond that and have already left her an email to get in touch with me last week. I'm driving myself kind of nutty right now since I can't seem to get in touch with anyone who knows anything...on top of DSS's mistakes that need to be corrected.

Can anyone shed some light/share your experience with homebirth and Medicaid? Do feel free to PM me as well!

[LilMomma83]

Our home birth or birth center birth would have been free with medicaide if we used a certain group within it (do you claim one?), unfortionatly it did not match with any of our other providers or the kids pediatrician who is too awesome to switch away from so we ended up not birthing with her.

When we went to visit her the first time (just to get to know her) the secretary looked into everything with our insurance and contacted us within a few days.

Good luck!

[imnottelling]

I had to switch to United from Amerigroup when I was planning my 4th's homebirth since Amerigroup stopped covering it sometime between my 3rd and 4th...Evelyn does take United Healthcare, and AFAIK, it's the only MCO available to cover homebirth with her at this time.

[secondimpression]

I've been reading through the member handbooks (my eyes are ready to fall out of my skull, so much information!) and UnitedHealthcare, MedStar and Amerigroup all have something to this effect in their maternity section: 

If you are a new Amerigroup member who is pregnant and have been seen by a non-Amerigroup provider for at least one complete prenatal checkup before you joined Amerigroup, then you may be able to keep seeing that provider throughout your pregnancy, delivery and up to 2 months after your baby is born, if the provider agrees to continue treating you.

Does this sound familiar to anyone? To me it sounds like a homebirth loophole. There's no outright exclusion for homebirth or any mention of midwives (home or hospital or CNM/CPM). And there's a section in each plan book where they explain you can switch your MCO one time within 90 days of enrollment. I haven't made it through the Priority Partners or DiamondPlan books yet nor have I gotten through the provider directories for any of the plans.

I know, I really should just be patient and wait for the midwives I contacted to return my calls. Not knowing what I'm supposed to do or what can be done is just driving me batty!

[Healthy_Baby]

2 homebirths with Evelyn while using Medicaid - with the first I jumped through EVERY hoop and learn ALOT about how this whole medicaid and mco thing works (or doesn't work)

 

When were you and who signed you up for the MCO? was this mco mandatory because of you medical circumstances? ther are some circumstances and timelines you could be within to change.

 

first: DO NOT call your MCO or case manager to ask about home birth, they won't know anything anyway (and it could only put up red flags and borrow trouble - if you can avoid any attention )  i did this and the women actually said "home birth? what is home birth?"

 

second: Call Evelyn's office directly and ask your questions. they will know specifically which MCO is best to work with at this time and whether or not they can work with Amerigroup.(i used that mco in 09 and had no problems but i know that can change) if possible ask if you can speak to Wendy - she is ABC's ins person, she very real and upfront and can answer a lot of questions.  (i'm gong to PM you with more info and thoughts)

 

regardless of whether the ins. will cover the home birth they will NOT cover the Birth assistant fee or any supplies purchased.

 

either way, after speaking with Evelyn's office you need to call the healthchoice hotline and make you complaints about you MCO. if you haven't already - if you were coerced or given no choice about the mco you may have a right to change.  There is an annual right to change one year after you first signed on - will that happen before your due date?

 

Edited by Healthy_Baby - 8/6/11 at 2:44pm

[imnottelling]

It did change -- I used Amerigroup from 05-fall of 09, when I was informed they wouldn't pay for homebirth anymore, and in Jan 10 I switched (that was my annual right to change) to United.

I do NOT like United nearly as much in terms of local providers, but I only switched myself, not my kids. I did have a hassle switching my newborn to Amerigroup like my other kids, but what isn't a hassle with DHMS? ;)

[secondimpression]

Originally Posted by Healthy_Baby 

2 homebirths with Evelyn while using Medicaid - with the first I jumped through EVERY hoop and learn ALOT about how this whole medicaid and mco thing works (or doesn't work)

 

When were you and who signed you up for the MCO? was this mco mandatory because of you medical circumstances? ther are some circumstances and timelines you could be within to change.

 

first: DO NOT call your MCO or case manager to ask about home birth, they won't know anything anyway (and it could only put up red flags and borrow trouble - if you can avoid any attention )  i did this and the women actually said "home birth? what is home birth?"

 

second: Call Evelyn's office directly and ask your questions. they will know specifically which MCO is best to work with at this time and whether or not they can work with Amerigroup.(i used that mco in 09 and had no problems but i know that can change) if possible ask if you can speak to Wendy - she is ABC's ins person, she very real and upfront and can answer a lot of questions.  (i'm gong to PM you with more info and thoughts)

 

regardless of whether the ins. will cover the home birth they will NOT cover the Birth assistant fee or any supplies purchased.

 

either way, after speaking with Evelyn's office you need to call the healthchoice hotline and make you complaints about you MCO. if you haven't already - if you were coerced or given no choice about the mco you may have a right to change.  There is an annual right to change one year after you first signed on - will that happen before your due date?

 

I was just enrolled in an MCO (Priority Partners, no thank you!) in the last 3 weeks and have 90 days to change. Otherwise I would have to wait for the aniversary which is a month after my EDD. With my last HB, I was with Blue Cross/Blue Shield so have kind of already been through the hoop-jumping and magic passwords and finding the one and only supervisor who knows anything. I did finally get in touch with Evelyns office (she was on vacation for a while there) and they are, in fact, considered in-network with United. But Thank You! Your info has been very helpful!

 

Originally Posted by imnottelling 

It did change -- I used Amerigroup from 05-fall of 09, when I was informed they wouldn't pay for homebirth anymore, and in Jan 10 I switched (that was my annual right to change) to United.

I do NOT like United nearly as much in terms of local providers, but I only switched myself, not my kids. I did have a hassle switching my newborn to Amerigroup like my other kids, but what isn't a hassle with DHMS? ;)

Seriously, why DOES this all have to be such a hassle? It took me 8 phone calls sitting on hold at least 20 minutes each time just to get to the darned receptionist at DSS. It's like they're hoping if they make it complicated and difficult enough to access care, you'll just give up and get with the program (or lack of).

DD is on DP's insurance so we have no issue with her and DS's pedi gave us her blessing to put off his next well baby visit until DP can add him and I to his health insurance (May '12).
 

[imnottelling]

Well, last year after I had my baby and wanted to put her on Amerigroup, they realized they lost all the identification I submitted the fall before and proceeded to cancel us.After fighting it and scrambling to resubmit everything, we got back on, except for me. Because I was born in Canada (but as an American citizen) and for some reason my case manager decided my American passport was not sufficient as identification (?!) Like she knows better than the federal US to check me out? It was fine based on policy, but try telling that to them. I had to have my mother out of state fax me my a copy of my certificate of birth abroad to submit it so I could get back on insurance 2 weeks postpartum. Grr.