Medicaid Birth Policy Targeted

(As reported 3/8/99)
The federal government has ordered doctors and hospitals to stop demanding cash payments from poor women for a popular procedure to relieve pain in childbirth, The New York Times reported Monday.

Medicaid patients may not be charged for prenatal care, delivery or other medical services related to pregnancy, according to federal law, and Medicaid reimburses doctors and hospitals for their services.

The national director of the Medicaid program, Sally Richardson, received reports that health care providers were requiring the cash payments for Medicaid-covered services, particularly the use of an epidural injection to lessen the pain of childbirth, she said.

In one instance, an obstetrician ordered the epidural withheld it from a woman in active labor because she hadn't paid for it and didn't have any cash, Richardson said. The doctor refused to take payment by check, credit card or moneygram. "Treatment of a Medicaid patient in this manner is not just a concern, it is alarming," she said.

Health policy experts reported complaints from patients across the country, but federal officials were unsure of the scope of the problem, the Times said.

Patients unable to pay cash for the epidural injection, which blocks pain in the lower part of the body, were often offered weaker forms of pain relief.

Doctors argue the reimbursements for pain relief treatment are woefully small, sometimes less than 20 percent of what private insurance companies pay, the newspaper said. A survey last year by the American Society of Anesthesiologists found that New York, for example, typically paid $55 to $105 for the epidural block, while insurance companies often paid more than $800. Medicaid covers the bills in more than a third of U.S. childbirths and those patients are caught in the middle.

The federal government's order follows the enactment of a California law that prohibits hospitals from denying anesthesia to women during childbirth based on their ability to pay for the procedure up front.

The law, which went into effect Jan. 1, arose from a case involving a Medi-Cal insurance patient who was denied an epidural while in labor at Northridge Hospital Medical Center in Los Angeles. An anesthesiologist had demanded she pay $400 in cash for the pain-control procedure.