I have always accepted Medicaid reimbursement because I believe that every birthing person and their family deserves the care and the birth they want, regardless of income or ability to pay. Unfortunately, accepting Medicaid has become unsustainable for my practice.
Medicaid has always been a break-even situation at best. In some instances, especially in the event of a transfer in labor, I pay to provide care because reimbursement doesn’t cover out-of-pocket costs. Still, I have continued to accept Medicaid because it simply felt like the right thing to do.
Current managed care plans pay 20 to 28% less than Medicaid did twenty years ago while every overhead has increased. When adjusted for inflation, that amounts to nearly a 50% cut and this is not sustainable.
Now some managed care plans have created a new set of requirements for out-of-hospital birth. Those requirements are far more restrictive than our legal scope-of-practice, are impossible for Florida Licensed Midwives to meet and essentially limit covered care to prenatal and postpartum care for a very select few.
Medicaid can work for large group practices where the lower rates of reimbursement can be offset but taking on more patients, a business model that is impossible for a small midwifery practice. The level of commitment and the amount of time invested in providing individualized and personal care, the very essence of midwifery, cannot be provided on a large scale.
What can you do? Contact your state representatives and demand change. Contact your managed care plan and demand change.
In the meantime, I am exploring options including a sliding scale system for those who qualify for Medicaid. For now I plan to continue accepting Medicaid on a very limited basis for established patients. I remain committed to serving families who are also committed to midwifery care.