Medi-Cal Moves to Encourage More Private Obstetric Services

In the hopes of encouraging more private obstetricians to treat low-income pregnant women, state Medi-Cal officials agreed in court documents filed Thursday to adhere to a higher payment rate for doctors and to speed the payment of their claims.

A coalition of legal aid attorneys negotiated the settlement to resolve a class-action lawsuit they filed 18 months ago on behalf of thousands of low-income women statewide who were unable to find private doctors to care for them during their pregnancy. In more than a dozen counties across the state, not a single obstetrician would treat pregnant women on Medi-Cal, the attorneys charged.

“I hope this marks the turning point in the decline of obstetrical services to these under-served women and will help bring back the many doctors who have dropped out of Medi-Cal,” said Dr. Benson Harer, chairman of the California district of the American College of Obstetricians and Gynecologists.

Low reimbursement rates and a cumbersome claims process have triggered a “mass exit” of obstetricians from the Medi-Cal program that insures about 100,000 pregnant women annually, said Standley Dorn, one of the attorneys who brought the lawsuit.

Between 1985 and 1987, when the lawsuit was filed, there was a 15% decline in the number of private physicians in Los Angeles County who provided obstetrical care for Medi-Cal women. There were also declines of 27% in Sacramento County, 12% in San Diego County and 19% in Santa Clara County, according to attorney Robert Newman, who also represented the women in the suit.

One plaintiff in the lawsuit, a pregnant Fullerton woman insured by Medi-Cal, claims to have called 10 obstetricians in her community and found that none of them accepted Medi-Cal. She charged that when she went in search of a doctor at an Orange County hospital, she was told that none of the obstetricians with admitting privileges there accepted Medi-Cal.

Under the terms of the settlement, which will not be final until September when it is scheduled to be approved by a federal district judge in Sacramento, state health officials agreed to speed the processing of doctors’ claims, promising to pay 90% of them within 25 days and 99% within 85 days. Also, state health officials will set up toll-free telephone lines to answer doctors’ questions, and physicians will be able to instantly confirm a patient’s Medi-Cal eligibility through a computerized telephone verification system.

Since the lawsuit was filed, the state has gradually increased payments to doctors for prenatal care, delivery and postpartum care from $650 to more than $1,000. The settlement commits the state to continue this rate.

State Deputy Health Services Director John Rodriguez said the settlement ‘represents “a lot of movement and a lot of progress. . . . I’m glad we got it settled.”

“It’s now possible for obstetricians . . . to give care and break even,” Dorn said.

Wendy Lazarus, with Children Now, a nonprofit, children’s rights organization, hailed the settlement’s provisions as “a really hopeful sign” for women and babies statewide.

She said the most recent state health department statistics for 1986 show that 7.3% of the 480,000 women a year who give birth in California receive late or no prenatal care. Compared to other states, California ranks 36th in terms of the percentage of women receiving adequate prenatal care.

Studies have repeatedly shown that spending money on prenatal care is cost effective because it helps prevent the birth of premature, low-weight infants who are prone to mental retardation and other handicaps that require costly medical care.