It’s been hard to articulate the reasons for our withdrawal from Medicaid. As the obstacles to our effective participation with Medicaid have dragged on, Joel and I felt it was time to share the reasons as we understand them.
Below is the text of a letter we drafted to share with anyone who is affected or disappointed or curious about our decision.
To Patients Affected by Changes to Medicaid Policy
To those affected,
After much hand wringing and discussion at MMC, we have stopped taking Medicaid clients. It was a tough decision, but necessary. The following list describes the reasons for our change. Many of these reasons stem from government enforcement of rules that are currently poorly defined by our Federal and State regulators
- Medicaid regulations prohibit Medicaid patients from paying out-of-pocket for services that are covered by the Medicaid program.
- Providers cannot knowingly bill Medicaid patients for covered services. To do so is considered “fraud.”
- Essentially all MMC services are now covered, but how they are covered is unclear.
- To date, MMC has received only vague guidance for how to credential and bill for our services.
- Birth center facility fees have been mandated as payable by Federal law effective January 1, 2011, but no pricing or rules for how to bill have been established by the State of Colorado.
- To continue serving Medicaid patients would be to continue providing services with an unknown financial and legal liability.
- MMC requires education for many of our clients and uses subcontractors to lead that education.
- In the new Federal law, these services would be included in our facility fees, but we have no pricing or billing guidance.
- Resolving this guidance will require a lengthy and detailed process to establish codes, requirements and the necessary credentials for instructors.
- Medicaid pays very low rates for our services, yet has higher administrative costs.
- Medicaid billing systems do not work with the billing system we use for all other third party payers (insurers, CHP+, Tricare, etc.).
- Colorado’s provider credentialing process is distinct from all other payers.
- The State’s billing response is often delayed by budget cuts and partisan haggling.
- Medicaid is reluctant to pay MMC for our newborn care services.
These are BIG problems and MMC would love to be part of their solution, but we will need leadership from the State and a non-profit organization that can continually advocate for the maintenance and improvement of Medicaid policies regarding birth center care.
Tracy Ryan, CNM
Mountain Midwifery Center