Low-income women in Oregon who want to have their babies at a birth center or at home are covered by the Oregon Health Plan if they meet certain criteria. OHP is Oregon鈥檚 Medicaid program.
But midwives from around the state say it鈥檚 so difficult to get state insurance approval that women鈥檚 choices in childbirth are in jeopardy.
Anna McDonald鈥檚 baby鈥檚 due next week.
鈥淚 am extremely excited about having this baby,鈥� she says. 鈥淚t鈥檚 our first, and it was very planned, so it鈥檚 just a dream come true for us.鈥�
McDonald鈥檚 husband is a dishwasher and she is currently unemployed. She lives in Lebanon, Oregon and gets her insurance from the Oregon Health Plan, the state鈥檚 Medicaid program.
McDonald wants to deliver her baby at a freestanding birth center close to her home, which is run by state-licensed midwives who offer a homebirth style of care for women wanting to have a more natural birth experience.
However, McDonald鈥檚 request to deliver her baby at Growing Family Birth Center was denied. Judging by case documents reviewed by JPR, the denial was based on administrative reasons, not health or safety concerns. Anna and her midwife appealed the denial.
鈥淲e requested an expedited hearing,鈥� she says, 鈥渟o we could get it taken care of before the baby鈥檚 here because I am 38 weeks 4 days pregnant right now today and they denied my expedited hearing because they said it wasn鈥檛 a medical emergency and when we did finally find out when my hearing was supposed to be, it鈥檚 set for 12 days after my due date.鈥�
McDonald鈥檚 midwife, Debbie Cowart, owner of Growing Family Birth Center, is perplexed.
鈥淚t doesn鈥檛 make any sense,鈥� she says, wearily.
Cowart鈥檚 voice sounds tired because she鈥檚 been up all night, having just delivered two babies in two days.
She鈥檚 a state-licensed midwife with 25 years of experience in out-of-hospital births. She says that the Oregon Health Authority makes it unnecessarily difficult for pregnant women to have midwife-assisted out-of-hospital births.
Cowart says what鈥檚 happening to McDonald is emblematic of the problems Oregon midwives have to deal with when they try to use the Oregon Health Plan.
鈥淚t鈥檚 very stressful for us as providers but extremely stressful for pregnant women who are under enough stress as it is just navigating their pregnancy, wanting to have this plan and always feeling like at any moment they can just deny their request.鈥�
In fact, pregnant women who are approved to deliver out of the hospital can have that approval revoked at any time, even after their baby is born. Combined with the low reimbursement rates for out-of-hospital birth care, this has put so much financial and emotional stress on midwives and their clients across the state that many midwives no longer take Medicaid clients.
Cowart says she鈥檚 one of the only midwives in Linn County who continues to accept OHP.
鈥淭he majority of the midwives I know in the mid-Willamette valley鈥擜lbany, Corvallis, Lebanon, and north鈥攈ave withdrawn from being Oregon Health Plan providers,鈥� she says.
Cara Frantz is a homebirth midwife who has been practicing in Southern Oregon for nine years. She recently decided to no longer care for women on OHP.
鈥淭hey have a system in place that allows them to claim that they鈥檙e supporting choice of birth,鈥� Frantz says. 鈥淏ut in function they make the system so difficult and so many hurdles to jump through that it鈥檚 forcing midwives to stop accepting it."
The Oregon Health Authority declined JPR鈥檚 repeated requests for an interview.
In written materials, the agency claims it has a growing number of midwives eligible to request coverage for their out-of-hospital clients. Though it declined to say how many claims are actually submitted by those midwives, the agency also says it currently approves 90 percent of requests.
The agency says the only way a woman could be denied coverage after birth is 鈥渋f her provider had never obtained approval before delivery.鈥�
But it is that very approval that Anna McDonald has been trying to obtain. So she鈥檚 in a holding pattern, not sure if her baby will come before or after the hearing.
鈥淭his is a completely absurd situation,鈥� she says. 鈥淚 think they are taking advantage of someone like me, who鈥檚 in kind of a precarious position here. You know, I could have my baby any day, and they鈥檙e just saying, 鈥榯ra la la, we鈥檒l figure it out when we figure it out.鈥欌��
A spokesperson from the Oregon Health Authority would not comment on Anna McDonald鈥檚 situation, citing privacy concerns. The agency says it quote 鈥渟upports the ability of every mother covered by the Oregon Health Plan to deliver in a safe, supportive, and comfortable environment.鈥�
But if Anna McDonald鈥檚 experience is any indication, it looks like the agency is falling short of that goal.
