UCSD to End Prenatal Care Plan for Poor : Health care: Head of program says shutdown is caused by lack of funds, but critics suggest that money is not the issue.

Blaming Medi-Cal reimbursements that in fact have increased by more than a third in the last two years, UC San Diego is shutting down the only major program in the county under which poor women get access to comprehensive prenatal care.

The action, announced in an Oct. 16 memo, raised eyebrows from San Diego to Sacramento. UCSD’s complaint that Medi-Cal obstetrical rates are too low doesn’t make sense, critics said.

“No one else seems to have a problem with those rates,” said Dr. Rugmini Shah, chief of the maternal and child health branch of the California Department of Health Services.

Dr. Robert Resnik, head of the Department of Reproductive Medicine at UCSD Medical School, said the Comprehensive Perinatal Program will begin phasing out in November because the state had withdrawn special block-grant funding. This money has funded the program for several years.

In the program, up to 130 women a month have received regular prenatal care from UCSD nurse-midwives who saw the women at community clinics, then delivered their babies at UCSD Medical Center.

Under Medi-Cal obstetrical plans implemented over the last two years, instead of block-grant funding, the program would have been reimbursed at a rate of $2,155 per birth for a package of prenatal and postpartum care, support services such as nutrition education, and the delivery.

Resnik said this just wasn’t enough to keep the perinatal program in business.

“Our present projections are that the best of these schemes would require $250,000-$300,000 in donated physician care and approximately $100,000 additional program support yearly,” Resnik wrote in a memo distributed Monday.

The program’s enrollment will be cut to 20 a month over the next three months, and the last delivery will come in April, the memo said.

The death of the perinatal program comes after a year in which UCSD had steadily squeezed down the patient load. The gradual cutbacks had prompted suspicion among others involved in prenatal-access issues that UCSD was backing away from caring for the poor. Resnik denied plans to kill the program as recently as late July.

On Tuesday, doubts remained. Janice Bluemer, who recently left as the county’s prenatal care coordinator, echoed Dr. Shah’s skepticism about the claim that the new Medi-Cal reimbursement rates are the problem.

Bluemer noted that UCSD’s perinatal program started as part of a state pilot project, whose success provided justification for the new higher Medi-Cal payments for “comprehensive” prenatal care.

“They were actually one of the pilots that proved that this is a cost-effective method,” Bluemer said. “What are we saying, that it was effective then, before all this legislation went into effect, but now it’s not?”

Shah noted that the higher Medi-Cal reimbursement system had increased doctors’ participation in the Medi-Cal system statewide.

In 1989, there were 3,889 births in San Diego County to women who had no prenatal care. These women show up in emergency rooms for delivery, and deliver babies who are more likely to have birth defects or be premature.

At UCSD, such “no-care” births amount to about 175 a month.

Reacting to Resnik’s announcement of the perinatal program’s shutdown, UCSD Medical Center officials stressed that the prenatal care program was operated by the medical school, not the hospital.

The hospital itself will continue to care for a limited number of poor pregnant women through its outpatient clinic and will also do deliveries of women who arrive in the emergency room, said Mary Margaret Olin, associate director of hospitals and clinics.