Switching providers with Medicaid?

[HeatherB]

A friend of mine is planning her VBAC. They are on Medicaid and have an OB at the local hospital that has the best rates for VBAC and best services, as well. Unfortunately, the ob is turning into a problem. She started care "late," and he wants her to have SIX u/s because of it (and her first was only HALF a week after his "cutoff" for this protocol . They've diagnosed her as GD, even though her results were borderline and only on ONE out of the 4 draws on the 3 hour test. Even the dietician says she's NOT a GD!

I've told her repeatedly that she can say NO, but she says that when she does, they get ugly - i.e., nurses, doc, etc. She doesn't want to be at odds for the next 6 weeks or so until the baby comes, BUT she doesn't feel like she has a choice.

She told me the Medicaid is an HMO type thing. But can't you still switch?! Does anyone know the ins and outs of Medicaid? The trouble, of course, is finding another supportive provider. Are there any MWs who take Medicaid?! I don't think she wants a homebirth, but I just want her to have a GOOD birth!

Help!

[Liquesce]

Medicaid is pretty diverse in terms of regulations, being administered by states rather than by one national law, so it's really hard to say without knowing what state your friend is in. In PA at least -- and maybe it's a part of the national guidelines, I don't know -- you are free to change your primary care physicians at any time, and you are free to change between the available HMO plans at any time, so if one plan doesn't cover a doctor of choice and another does it's not a big deal to switch between them. In my area there are CNMs who accept medicaid, so again while I can't know what options are available to your friend, I can say that it's not a situation in which national medicaid law says maternity care must be administered only by OBs.

If she's on medicaid she should have a social services case worker -- she could contact her case worker to find out what her options are in terms of changing HMOs if need be, if there's more than one. She should also call her HMO and ask them where she can find a list of covered providers if she doesn't already know, and how long it normally takes to process a change from one to another.

[HeatherB]

Liquesce, thanks very much for this info! She's also in TX (just faaaar away in another part from me!). This is very helpful!

[AugustLia23]

I can't speak for Texas, but in MA the free health care is very good(for what it is). Not only are there multiple providers, which you can change at will, but you can also change your health plan among the masshealth options.

[sarabrynn82]

Just wanted to say that I'm in Texas, on Medicaid, and planning a birth center birth with a CNM... haven't had experience with changing provider's, but wanted to say that some midwives are covered through medicaid!

[HeatherB]

Thanks, mamas! I've looked for CNMs on the policies I think she has access to - none. But hopefully with the info I've sent on to her she can find out if there's anyone out there better than whom she's with now. At least we know she CAN switch (up to 4 times/year) if she wants to!

[PPK]

I'm in TX and went from OB to CNM at a freestanding birth center and had to change carriers within Medicaid. The birth center accepted Community Choice and not Amerigroup which was what I had. All I had to do was call Medicaid (Texas Star) and have them switch me over. It takes 4-6 weeks (?) to change over, but until that time the birth center just called Amerigroup and they (Amerigroup) still covered me until the changeover as an out-of-network provider (I think that's what its called when they're not typically covered). It didn't seem like they had much choice in the matter. Any more questions feel free to email me! But it was very easy!!

[Defenestrator]

Originally Posted by HeatherB

Thanks, mamas! I've looked for CNMs on the policies I think she has access to - none. But hopefully with the info I've sent on to her she can find out if there's anyone out there better than whom she's with now. At least we know she CAN switch (up to 4 times/year) if she wants to!

I don't know what it is like in your state, but in my state CNMs are not listed in provider directories, only the doctors who supervise them. In fact, when I go to a CNM for well-woman care, on the bill it appears as if one of the Drs. in her office did the work.

The best way to find out if a CNM takes a certain insurance, in my experience is to get a list of them from a directory like ACNM and then call the office itself and ask if they take a particular insurance.

CNMs also often work in state-funded clinics caring for pregnant women and sometimes those providers don't show up at all on directories.

[HeatherB]

Originally Posted by Defenestrator

I don't know what it is like in your state, but in my state CNMs are not listed in provider directories, only the doctors who supervise them. In fact, when I go to a CNM for well-woman care, on the bill it appears as if one of the Drs. in her office did the work.

The best way to find out if a CNM takes a certain insurance, in my experience is to get a list of them from a directory like ACNM and then call the office itself and ask if they take a particular insurance.

CNMs also often work in state-funded clinics caring for pregnant women and sometimes those providers don't show up at all on directories.

Great point! I have another friend who recently delivered with a CNM in a similar arrangement. Not sure my friend wants me pestering her with MORE info at this point but I will pass it on!

Thanks for all of the input!!

[phathui5]

I'm on the state insurance (MCHIP) in MD planning a home birth with a CNM. She should definately have other options. I'd tell her to call the midwives in her area and ask if they take the group that she's with.