Medi-Cal Mothers’ Babies Face Increased Risks, Study Shows

Fewer doctors are providing maternity care to indigent women because Medi-Cal reimbursements are not high enough, thus increasing the health risks to new-born babies, a Los Angeles health policy group said Sunday.

The group, the National Health Law Program, which released a study on the trend, said that rising medical and malpractice insurance costs and delays in reimbursement have increasingly “forced” Medi-Cal providers throughout the state to drop out of the program.

The result, said Stan Dorn, attorney for the health law program group, is that some pregnant women who are on Medi-Cal cannot find doctors who will accept them as patients. In some predominantly rural counties, there are no doctors willing to accept Medi-Cal payments, the report said.

Babies born without any prenatal care, doctors say, are more likely to suffer from mental and physical handicaps. Chances are also greater that they will die at or soon after birth.

“For many low-income women, Mother’s Day is a reminder of miscarriages that have taken place, of children that will suffer lifetime disabilities or handicaps,” Dorn said at a Santa Monica news conference.

Costs to private-care patients in California for prenatal visits, delivery and one postpartum checkup run between $1,000 and $2,000, Dorn said. But Medi-Cal reimbursements for such care is limited to $518.

The state Department of Health Services hopes to lure doctors back into the program by increasing the payment to $650. A proposal by Assemblyman Burt Margolin (D-Los Angeles) that was approved Wednesday by an Assembly subcommittee would provide up to $800 per case.

Advocates of increasing the Medi-Cal ceiling say such a move will save the state money in the long run, because there will be fewer seriously ill infants.

Between 1982 and 1984, the number of obstetricians willing to accept Medi-Cal payments dropped 14%, and the decline has gotten steeper, said Wendy Lazarus, director of the Los Angeles-based Southern California Child Health Network. Meanwhile, she said, the number of babies born to women on Medi-Cal is on the rise.

“Pregnant women on Medi-Cal have no place to go for prenatal care except the hospital emergency room,” said Lazarus, who also attended the news conference.

According to the National Health Law Program report, in 15 small counties with more than 13,000 women of child-bearing age eligible for Medi-Cal, no obstetricians participate in the program. In 11 larger counties, including San Bernardino and Fresno, so few doctors participate that most low-income women are effectively denied care.

In Alameda County, for example, there were more than 25 Medi-Cal maternity care practitioners in November, 1985. By the middle of last month, there were only three, Dorn said.

Pregnant women in Los Angeles County have been subject to delays in receiving care, and many simply do not know where to go when their doctors stop treating Medi-Cal patients, said W. Benson Harer Jr., vice chairman of the California district of the American College of Obstetricians and Gynecologists.