Mothers’ Helpers : Prenatal Program Benefits Indigent Women, Taxpayers

Marta Prietto O’Hara remembers the frantic call last August from a 32-year-old welfare mother who had four children and was expecting a fifth as the result of a rape. That wasn’t the mother’s only calamity: her 15-year-old daughter who lived at home was also pregnant for the second time.

The distraught woman had called “the right place,” said O’Hara, a social worker at the Maternal Outreach Management System, or MOMS.

MOMS links a select group of pregnant women who are on Medi-Cal with the prenatal medical care and social services they need to bear healthier newborns.

The Orange County-based program, which is supported by private and government funds, is intended not only to help indigent women and their babies, but also to save taxpayers’ money by cutting the need for costly high-tech care of premature infants.

It targets pregnant Medi-Cal recipients who have difficulty with English or lack other skills needed to tap into the medical system, providing them with the prenatal care common to the middle class.

The MOMS program--created in January, 1993--already has won kudos from state health officials and doctors who say they will encourage the development of similar prenatal programs statewide if MOMS proves cost-effective.

MOMS was born of an obstetrical crisis the county faced in 1989.

At that time, UCI Medical Center in Orange stunned the community when it began turning away some poor pregnant women who showed up at their emergency room ready to deliver. The hospital said it could no longer afford to absorb the cost of these births, which often require expensive postnatal care for premature and underweight infants.

Other hospitals were reluctant to fill the gap. At the same time, the county’s prenatal medical clinics were packed with patients, rejecting as many Medi-Cal cases as they treated. And private-practice obstetricians were not eager to accept low-reimbursement Medi-Cal patients.

In response, the county set up a task force of doctors, health-care personnel, social workers and others to devise ways to stem the soaring cost of Medi-Cal births.

In 1992, the last period for which the state has data, births in Orange County cost Medi-Cal $42 million, up from $35 million the previous year. Contributing significantly to the growth was a federal mandate that in 1988 extended Medi-Cal benefits to illegal immigrants for prenatal care and childbirth.

One of the group’s recommendations was to create a public-private partnership to ensure that more of the county’s poor pregnant women receive full-spectrum prenatal care.

That partnership became MOMS.

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In the case of the pregnant mother and daughter who called O’Hara, MOMS workers found them a common obstetrician and placed the daughter in a special program for adolescent mothers. But the agency also kept contact with the pair, offering personal assistance with the problems of pregnancy and poverty that seemed to overwhelm them.

When the family’s telephone was disconnected for non-payment, O’Hara went to their apartment to arrange same-day doctors’ appointments. And when they missed appointments, O’Hara would show up at their home to keep them on the check-up regimen.

The two mothers delivered healthy, full-term babies, she said. Now they are receiving training in parenting and family planning.

Is MOMS the answer? It’s too early to tell, say its advocates, but the trends are hopeful.

Of the 811 women who entered the program in its first year, 100 have given birth, with the newborns averaging a healthy 7 pounds, 3 ounces. There was only one severely pre-term delivery at 26 weeks.

While the 811 pregnancies just scratched the surface of the almost 10,000 Medi-Cal pregnancies in the county last year, officials at MOMS say the program successfully targets those Medi-Cal patients who most need help in obtaining medical and social services.

Women are referred to the MOMS program from county pregnancy testing clinics, from a countywide medical referral service and by word of mouth.

At MOMS orientations held weekly in Santa Ana and Anaheim, women not yet on Medi-Cal are instructed how to apply, and a public health nurse record the women’s histories, looking for special medical or social problems, such as an abusive spouse, which could add to the risk of their pregnancy.

In addition, MOMS acts as “a matchmaker” between patients and physicians, offering the women a selection of doctors, including some who provide Spanish interpreters, said Dottie Andrews, MOMS executive director.

A key component of the program is its intervention with illegal immigrants, who often have the most difficulty in finding medical care.

“We see many women having their first child in this country,” Andrews said, adding that MOMS specifically welcomes undocumented pregnant women, emphasizing they are entitled to the health care by law.

The federal order extending state Medi-Cal maternity benefits to illegal immigrants was done in part because authorities realized it would be less costly than providing medical care for their sick or handicapped offspring, who are American citizens, said the state Department of Health Services.

As of January, there were 9,876 women in Orange County receiving pregnancy services through Medi-Cal; 5,449 of these were illegal immigrants. MOMS officials estimate that 90% of the women referred to MOMS are Latinas and 50% to 60% are illegal immigrants.

And while MOMS previously dealt with a relatively light caseload, it has expanded its staff to assist 2,000 women this year.

“We started small to really develop our model program,” Andrews said, concentrating first on central Orange County, which has the largest number of women with late entry to prenatal care. Soon, they will be doing community outreach through churches and community centers countywide.

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One of the programs’ major accomplishments has been linking women with physicians earlier in their pregnancy, in part by more quickly qualifying them for Medi-Cal, Andrews said.

Officials once thought MOMS’ biggest challenge would be to find physicians willing to accept its clients. But Medi-Cal patients became much more attractive to private obstetricians because Medi-Cal has increased its reimbursement rate for maternal care, and the recession has coincided with a leveling off of once-soaring birthrates, Andrews said.

“I have doctors calling who never wanted anything to do with Medi-Cal and have changed their minds,” Andrews said.

In addition, MOMS strives to lighten the work of these doctors. Dr. Mitchell Lew, an Anaheim obstetrician / gynecologist, said MOMS faxes medical histories to physicians and also teaches its clients good health habits.

Dr. Gerald Wagner, maternal and child health director for the county, said MOMS also pushes Medi-Cal patients to keep their appointments.

“You can’t maintain a private office and livelihood if an appointment book is filled with people who don’t show up,” Wagner said.

Based in Irvine at offices donated by Tokos Medical Corp., MOMS has a staff of 11, including two public health nurses and four paraprofessionals provided by the county. It operates on a budget of $200,000 a year in grants, which have been guaranteed through the end of the year.

Jacqueline Ward, a nurse consultant with the maternal and child health branch of the State Department of Health Services, called MOMS “an excellent example of public-private partnership in allowing high-risk women to access prenatal care.”

Andrews said she expects MOMS will prove itself financially since “the minimum savings in preventing one pre-term birth is about $50,000 in hospitalization costs for the premature infant.”

Perhaps, not surprisingly, mothers who know the program are also ready with praise.

Elfega Gonzalez, 20, who attended a recent MOMS orientation in Anaheim with a 20-month-old toddler in tow, recalled her first pregnancy in Mexico as extremely difficult. She did not seek care until she was severely ill.

Again pregnant, Gonzalez said, she had come to MOMS just six weeks into gestation to avoid similar problems.

One veteran of the MOMS program, Casey Cooper, a 20-year-old department store clerk who lives in Santa Ana, said when she was losing weight in her fifth month of pregnancy, MOMS referred her to a nutritionist.

The young woman said the nutritionist showed her how to plan more balanced meals and gave her vouchers so she could buy milk, cheese, eggs and other healthful food.

“I realized I really wasn’t eating enough and probably was eating too much junk food,” said Cooper, a petite woman who subsequently gained 20 pounds and last month gave birth to a healthy boy.