Why were you denied for Medicaid? I'm just curious, because depending on the state it's rare for them to deny any pregnant woman so I was hoping I could give you some advice in that department because I use to work at social services & sometimes people are just denied in errors of paperwork & sometimes it can be hard to take care of if you aren't aware of it, just because they are so busy & it's hard to get a real person to deal with, as much as I hate to admit it.
Before my social service days, I also worked at a county health clinic. I think it depends on the clinic, but where I worked it was exactly like the local OB & midwife office. Same care providers even, they just took turns on different days. We could never promise anyone the same OB or midwife, so some people didn't like that, but we did have fairly decent care providers. Of couse, that depends on your midwife or OB. Just like if you go to an office that isn't the health dept., it can be a hit or miss, you know? I liked most of the providers we had, they were actually fairly low intervention & didn't push testing or inductions. We did have a couple older OB's I wasn't a huge fan of, just because they believed tearing in labor was bad, much better to "get a controlled cut" as one said while I cringed. But if a patient didn't want it in labor, they didn't push the issue or attempt to debate the clients. We also were limited on days & hours we took pregnancy patients, only had morning appointments on certain days which caused problems with come clients. We had some clients who used our services while they were insured or had Medicaid, just because they actually liked the clinic better & knew it was actually less busy than offices around town. But, again, it can really depend on the office.
As far as a sliding scale, if you're really not into the idea of the health dept., many practices will do the same for the cash paying patients. Don't know where you're at or what you're looking for birth wise, but homebirth midwives, even paying their full fee out of pocket, would be less than cash paying a provider, on top of the hospital bills. Not that you should go that route just because of cash, but if it's something you'd want to learn about anyway it never hurts to consider all your options.