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Midwives Left Out of New Health Plan?

Big changes are coming with the implementation of President Obama’s Affordable Care Act, and some local midwives are worried that low-income clients from the Oregon Health Plan (OHP) will be lost in the shuffle. OHP services in Lane County have historically been provided through Lane Independent Practice Association and LaneCare, but beginning Nov. 1, those services will be provided by Trillium, Lane County’s new coordinated care organization (CCO). 

“We have been covered by the OHP open card, historically, and the open card is going to be going away,” Erin Lusk of Sacred Waters Birthing Center says. “As of now, we’re not included as providers with the new coordinated care organization in the area.”

Debi Farr, spokesperson for Trillium, says that PeaceHealth’s Nurse Midwifery Birth Center, located near RiverBend, is included on Trillium’s provider panel. Farr says, “What we’re suggesting is that lay midwives encourage their patients to seek a credentialed provider through Trillium until it is determined if and when the lay midwife services will be included in the CCO.”

Susan Jenkins, attorney for the American Association of Birth Centers, says that under the Affordable Care Act, a geographic area has to include a freestanding birth center, if one exists, in its coverage. A freestanding birth center, she says, bills as itself instead of through a hospital. She says that “lay midwife” is an inaccurate term for organizations like Sacred Waters, which employs certified and licensed midwives. Their services include birth center and home births, suturing, some pharmaceuticals, IV therapy, oxygen, injections and CPR if necessary, and the midwives are recertified every two years.

“The managed care organizations don’t like to pay for any kind of midwife and they never have, and it’s been necessary in various states at various times to make complaints to the federal government because of problems with the Medicaid agency or the Medicaid plans not covering to the full extent that the federal government requires us,” Jenkins says. “I always think that it may be because the physicians in an area don’t want the midwives to be able to be compensated.”

“We just became a CCO Aug. 1,” Farr says. “We’re still figuring a lot of things out, too.” she says that Trillium will finish its transformation plan in November, and it will probably be January 2013 before the CCO has a completed application and credentialing process. “It’s very important that we develop an appropriate process, and that’s going to take time,” she says.

Anita Rojas, founder of Sacred Waters and certified professional midwife, says that many of her clients would choose to try to give birth, unassisted, in their homes before they would utilize care associated with a hospital. She says that among other reasons, some women have had negative birthing experiences in hospitals and want to participate fully in their medical decisions with options to decline or delay unwanted procedures.

“Some people feel really, really strong about their birth choices and their bodies. They’re afraid to go to a hospital and be disrupted,” Rojas says. “This is why it’s vital that the insurance pays so that this birth center remains open and remains an option because it’s the only one in Lane County that’s a freestanding birth center, independent from the hospital.”

Elise Hansen, a Eugene-based certified professional midwife, says that compared to midwifery births, hospital births without complications probably cost two to three times more. “I really don’t understand how the state can justify it on a financial basis either,” she says of delay or possible exclusion of independent birthing centers and certified midwives.

Rojas says that Sacred Waters’ clientele is between 70 and 80 percent OHP members, and the center must be included in the new CCO as soon as possible. Hansen says she also sees a lot of OHP clients. “This is to prevent a gap in the care for clients who are currently pregnant and will not give birth until after the transition happens, well after the first of the year,” Rojas says.

Hansen says, “There is no straightforward method by which we could become part of the CCO. There’s no process to be able to become part of this. We get a runaround when we are trying to ask people how to do it.”

Sacred Waters will host a viewing of the film Freedom for Birth at 6 pm Thursday, Sept. 20, at 2035 W. 12th Ave. with a discussion to follow. — Shannon Finnell