Rural Alabama Health Alliance
Position Paper
Most rural Alabama counties do not have doctors to provide
maternity care or deliver babies. Poverty among rural women
delivering babies and the costs of providing such care had not
made maternity and obstetrics care feasible for local physicians
to provide prior to the Medicaid Maternity Waiver Program.
Until then, the state Health Dept. had used public health nurses
to provide local prenatal care and referred women to city physicians
to provide delivery services. This separated prenatal from
delivery care and required women to travel to new, and at times,
strange facilities.
The Medicaid Waiver program was incentive for new physicians
trained in obstetrics and family medicine to establish practices
in underserved areas. These physicians provide comprehensive
maternity care, have helped small community hospitals to re-establish
maternity services, and have lowered Alabama’s high infant
mortality rates. To return to a system that disjoins prenatal
and delivery services would be a step backwards for Alabama.
We would expect to see infant health statistics decline and infant
death rates rise to previous levels.
The delivery of prenatal care is more cost effective than paying
for a poor pregnancy outcome--NICU (neonatal intensive care unit)
care for a premature or sick infant. It is the belief of
RAHA members that the reason services are improved in some rural
couties county (Pickens, for example) is because maternity care
is now provided locally, giving greater access to care than ever
before. If this access is hindered it will negatively impact
prenatal care. Such access can be diminished by diverting
patients to other providers, or by making the service too cost
prohibitive to provide locally.
Medicaid Maternity Waiver Program
As the controlling entity for the majority of patients in our area, those who make and enforce the rules for maternity waiver patients essentially control who provides care, for how many patients, and the reimbursement.
The State of Alabama has set up a Medicaid Waiver Contract
which goes to the lowest bidder.
It is more cost-effective for the bidder to consolidate the care
into one area and have the mountain (the rural patients) come
to Mohammed (the regional center), than to provide basic services
in more areas (which is more expensive). The patients who
do not come in for care, and have premature or sick infants, do
not affect the bottom line of the bidder (it comes from the general
Medicaid budget).
Recommendations
There is more to the puzzle than cost. If we do not spend money on maternity care, the cost will be born in other areas such as mortality and morbidity. Some possible courses of action are: