Workforce issues in Maternal and Child Health: Barriers to Private Provider Participation in the Medicaid Women's Health Waiver

Background: The Arkansas Medicaid Women's Health Waiver (WHW), begun in 1997, has resulted in over $500 million in cost savings and significant reductions in unwanted pregnancies. However, approximately 80% of women who receive family planning services through the WHW do so through the local health departments. Therefore, a survey to determine private providers' knowledge of WHW services and their perceived barriers to participation was included within the most recent WHW evaluation. Methods: The population surveyed included all Arkansas-licensed and practicing physicians, registered nurses and nurse practitioners providing health services to women of childbearing age. Dillman survey methods were used, yielding a response rate of 30%. Results: Among physician respondents, 73% did provide reproductive health services; 88% were aware of the WHW; however, only 39% participated. Among nurse respondents, 65% provided reproductive health services, 83% were aware of the WHW and 42% participated. Respondents were asked to select reasons why they believe that providers may have difficulty participating in the WHW. For both groups,, the only significant difference between WHW participants and non-participants was that non-participants were significantly more likely (t = 4.07 , p < 0.0001 for physicians; t = 2.58, p < .01 for nurses) to find that problems with billing Medicaid were barriers, not the actual reimbursement rates or other attributes of the WHW services. Qualitative responses provide further details about provider attitudes toward participation. Conclusions: Simplification of and training for the Medicaid billing process would do much to increase private provider participation in the Women's Health Waiver.