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APHA Scientific Session and Event Listing

Recorded presentation

Jo Anne Myers-Ciecko, MPH, Seattle Midwifery School, 4000 NE 41st St, Building D, Suite 3, Seattle, WA 98105, 800-747-9433, connie.koshewa@abccodes.com and Connie Koshewa, CPM, MPH, Research, Alternative Link, 6121 Indian School Rd #131, Albuquerque, NM 87110.

In 2001 the American Public Health Association called for increasing access to out-of-hospital maternity care services, specifically expanding access for underserved populations, eliminating barriers to reimbursement of direct-entry midwives. In the same year more than one and a half million births, or 37% of all births in the United States, were financed by Medicaid. This makes Medicaid the single largest payer of maternity care in most states. Decisions made by Medicaid programs in each state regarding benefits and providers directly determine whether or not low income women have access to out-of-hospital maternity services and direct-entry midwives. Medicaid policies often influence similar decisions made by private insurance carriers and thus impact access to these services for even more women.

This paper examines policies established by each state regarding benefit coverage of out-of-hospital maternity services, direct-entry midwives as recognized providers, and reimbursement practices. The authors will present data collected from each state and compare to related questions such as reimbursement methodology for nurse-midwives and state-mandated direct access to obstetrician-gynecologists. We will also present two case examples that illustrate how managed care contracting, malpractice insurance, and midwifery standard of care concerns have further complicated the question of assuring access in two states with a long history of direct-entry midwives providing care to women enrolled in Medicaid.

Learning Objectives: At the conclusion of this session, the participant will be able to

• List states that cover out-of-hospital maternity care services for Medicaid enrollees
• List states that recognize direct-entry midwives as Medicaid providers
• Identify two or more factors that impact women's rights to access these services
• Describe creative solutions to barriers identified in two case examples

Keywords: Access and Services, Midwifery

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation