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
8 SEPTEMBER 20, 2012
EUGENE WEEKLY
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
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