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'Improving Medicaid': Birthing centers, family planning and care for children

April 11, 2011 - Mary Ann Heath
My reading on Medicaid continues...even as the president and lawmakers weigh cuts to Medicare and Medicaid programs for the poor and elderly in order to reduce the deficit. I'm just beginning my reading of the bill, "Improvements to Medicaid," which includes coverage for freestanding birthing centers, concurrent care for children, a state eligibility option for family planning services and presumptive eligibility for family planning services. This part of the bill centers around amending the Social Security Act in some perceptibly minute, but important ways.

Birthing Centers: The bill allows for the payment for "freestanding birthing center services." Such centers are defined by the bill as a health facility that is not a hospital, where childbirth is planned to occur away from a woman's residence, that is licensed by the state to provide prenatal labor, delivery or postpartum care and that complies with other requirements relating to the health and safety of individuals provided services at the facility. A state can make separate payments to providers that administer prenatal labor and delivery or postpartum care in a freestanding birth center, such as midwives, or other providers of services recognized under state law. This is regardless of whether the individual is under supervision of, or associated with, a physician or other health care provider. This amendment to the Social Security Act provides women eligible to receive Medicaid more options when it comes to the birth of their children. More than 100 years ago, women primarily gave birth at home, and slowly this trend moved to a hospital setting. But, today, a woman has more choices when it comes to delivering a child. Hospitals and birthing centers may differ, and be similar on many levels--a topic for another blog at a later time. The important fact here is that a woman's choice on where to deliver a child shouldn't have to be made on finances alone.

Concurrent Care for Children: This section of the bill makes it possible for children to receive payments for hospice care, while also continuing treatment for terminal illnesses. The bill mandates that the voluntary election to pay for hospice care for a child will not constitute a waiver of any rights of the child to be provided with, or have payment made for services related to a child's condition, or diagnosis of a terminal illness. I don't see how any human being with a heart can argue against this. To think there was, perhaps, a loophole at one point that would allow for a child's hospice care to take away the child's rights for payment of treatment is unfathomable.

State Eligibility Option for Family Planning: This allows states the option to provide family planning services and supplies to eligible indivuals. These individuals are described as those whose income does not exceed the highest income eligibility level established by the state, that does not also exceed the highest income eligibility established under the state plan, who is a pregnant or non-pregnant woman. The bill restricts only the income of the recipient to be considered. Services provided are limited to: family planning services and supplies, including medical diagnosis and treatment services.

Presumptive Eligibility for Family Planning Services: The bill also allows the states the option to provide services to individuals who meet certain income eligibility standards during a "presumptive eligibility period." This medical assistance is limited to family planning services and supplies and at the state's option, medical diagnosis and treatment services. A "presumptive eligiblity period" is defined as starting with the date on which a qualified entity determines an individual may be eligible for services and the earlier of either: the day on which a determination is made with respect to the eligibility of such individual or if an individual does not apply by the last day of the month, following the month during which the entity makes the determination, such last day.

Family planning services are often-used, vital services for women. Though many infer family planning is synonymous with birth control, it encompasses much more. It also includes sex education and the prevention and management of sexually transmitted diseases. It includes preconception counseling, as well as infertility management. All of these items help maintain not only the health of women, but ultimately our children, and the overall health of society. Women of every income level need access to such care. Delta County recently encountered an outbreak of syphilis, surprisingly. Imagine if many of the carriers of the disease were low-income and had no access to treatment--the illness would only continue to spread.

Family planning services are essential to health of the community.

Mary Ann Heath has been reading and blogging about the Patient Protection and Affordable Care Act since January. Her goal is to read all 906 pages of the bill in one year.


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