Medicaid kicks off women requesting hb?

sara_m · 11-07-2009, 09:57 PM

Is anyone familiar with the Medicaid language that says you may lose your coverage for "requesting a home birth?" I live in Missouri and am trying to ascertain if this means the following... I plan a hb, but need to be transferred to a hospital. Medicaid then refuses to pay for my transfer because I have pursued a hb. If I call them and ask about a hb, will they immediately kick me off? I am so confused, and am afraid to cal them for clarification because I a may be booted. How is this legal??

Marlet · 11-07-2009, 10:01 PM

I was having an unassisted homebirth for DD1 when I transferred in (for pain killer). I was on Medicaid at the time (Idaho so rules might be different) and they covered it just fine. The staff knew why we were there but I don't know if they reported that part or anything. It might be one of those tricky things in regards to who the coverage is for. Here, any baby born is automatically given coverage so most items are billed to the babies coverage. Maybe it's like that where you are and anything that would be billed for you wouldn't be covered.

Worth calling and asking about for sure. I know you said you are afraid to but you can call and not give your info. You can leave it annoymous and just word it as a "for reference/in the future" type situation as opposed to a possible current one.

MsBlack · 11-08-2009, 05:51 AM

I would seriously doubt this is true, but of course I don't know the first thing about MO medicaid language--I only know that medicaid generally covers all kinds of med care. Even med care needed as a result of what the State may consider 'stupid/dangerous behaviour' of various sorts apart from birth. Yes, you can always call your local office to find out, and just don't give your name.

I am wondering though--where did this idea come from? Did someone tell you, or were you reading through the regs...? Just curious!

sara_m · 11-08-2009, 09:02 PM

I heard a rep from our local birthing center mention it, and I totally laughed it off thinking she must have some majorly wrong information. So, I happened to run across paperwork later that week and low and behold, that is exactly what it said! It's been on my list of things to do (you know, call and complain, try to contact a legal expert, go for a letter to the editor). However, I now find myself pregnant - surprise! - and am a little afraid to throw the same stink, as I can't afford for my family to lose our insurance coverage while my husband is in school full time. Aarrgh!

sunfish21 · 11-08-2009, 09:07 PM

A local midwife mentioned to me that a good plan is to have an "accidental" home birth...not a planned one. They can't fault you for having a baby that came too fast!

bicyclingbethany · 11-08-2009, 09:26 PM

That sounds crazy! They definitely can't kick you off for just calling to ask for clarification- that's not requesting a homebirth. I had medicaid for this birth, and they wouldn't cover the midwife's fees but would cover anything in the hospital.

Good luck! Dealing with medicaid is a pain in the butt!

MsBlack · 11-09-2009, 04:40 AM

I wonder if this caveat is about using legal vs illegal services~~?

But this gets back to calling, asking questions, clarifying medicaid's intent with this issue. Oy, what a pain.

Still, it is true that having a 'accidental' homebirth could be one way around this reg if there is no other way. You would hire a Dr (OB or fam. practice) who would be your 'official provider', and have a midwife with whom you plan to birth at home. Of course, that would mean paying out of pocket for the mw, although that could be true in any event since not all state's approve pmt of homebirth mws through medicaid--even where there are legal homebirth providers.

coloradomama1 · 11-09-2009, 07:30 AM

i checked this out for our hb too and was nervous. in colorado at least they don't require that you have prenatal care on record so you could just show up in case of transfer and act like you were planning to all along.

sweet.p · 11-09-2009, 08:04 AM

Since it's only since last year that home birth is legal in MO, maybe medicaid has not updated the rules about transfers.

Asking for clarification from medicaid seems like the prudent thing to do.

sara_m · 11-09-2009, 11:09 AM

I've made calls galore! Still waiting on clarification, but it appears as if it's just a way to get around covering home births. My managed care plan says they won't cover it, but the state plan will. However, the state says that if you live in an area that has a managed care plan you cannot transfer into the state plan. Arrrgh! I've left a few more messages, and will share what I hear. I AM a squeaky wheel, though, so it may happen yet. I started calling at 6 weeks pregnant with my last birth, and a week before she was born, I finally had written documentation that my insurance company would pay for my hb. Hoping I can be as obnoxious and effective this time ;-)

mamatolevi · 11-09-2009, 04:09 PM

The state ins commissioner might be able to provide clarification, or at least be able to get the ins reps to provide an answer in a timely manner.

MsBlack · 11-09-2009, 05:25 PM

YAY for the squeaky wheel! You go, woman

mamato3cherubs · 11-10-2009, 12:10 AM

Quote:

Originally Posted by sara_m

I've made calls galore! Still waiting on clarification, but it appears as if it's just a way to get around covering home births. My managed care plan says they won't cover it, but the state plan will. However, the state says that if you live in an area that has a managed care plan you cannot transfer into the state plan. Arrrgh! I've left a few more messages, and will share what I hear. I AM a squeaky wheel, though, so it may happen yet. I started calling at 6 weeks pregnant with my last birth, and a week before she was born, I finally had written documentation that my insurance company would pay for my hb. Hoping I can be as obnoxious and effective this time ;-)

Glad you posted. I have tried to follow the events surrounding the scene in MO over the last several years as my mom was lived there for 4 years (just came back to OR in June) and was working at Boone Hospital there in Columbia. I did not expect that the Medicaid plan would cover any homebirth there, but could not imagine that they could completely take away coverage for everything else because you chose to birth at home and pay out of pocket.
I can not fathom that they could force you to choose a certain care provider, but they could simple tell you who they will and will not pay for.

Here in OR our state program is OHP (oregon health plan) which is run essentially like an HMO. They will not pay fees for a homebirth midwife, but if you chose to do tandum care with a CNM or DR that is covered in your HMO then that would be paid for. There is a way around it here though, but it is not pretty. If you are already covered under the plan, it can not be changed. BUT if you are not, you can apply for what is call an "open card", which is essentially what you are given for care in immediate need, but not until the 3rd trimester of pregnancy. Under an open card any qualifying provided will be paid for, including a midwife for homebirth, as you are not locked into the managed care plan. It doesnt pay well, but better than nothing. And most midwives who will bill this way require the client to put deposit or pay the fees as agreed in a payment plan prior to the birth, then the amount covered by the state will be reimbersed.