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Do we take OHP for home births?

Oregon was one of many states that expanded their Medicaid program under the Affordable Care Act.  Regardless of your political views about the ACA, many more people have been able to get health insurance now under Oregon Health Plan (OHP).  And, it is also directed towards pregnant women to make sure they have health insurance to get adequate prenatal care.  So this is a step in the right direction!  Its vital to our families and communities to make sure that all pregnant women have health insurance and have safe and adequate prenatal care to help avoid and/or manage any issues that come up during pregnancy.  Its also important that with health insurance they have choices as to where they want to give birth and how they give birth.

So, at Portland Natural Birth, we feel its crucial to make sure ALL families get the care they want and need.  This means that yes, we do now accept OHP insurance!  But, unfortunately, OHP comes with many more strings attached than any of us would like.  It doesn’t stop us from accepting it and billing it, but it does come with a bigger conversation about what it means for our OHP families and what our care looks like under OHP.

The Oregon Health Plan (OHP) has their own guidelines for out of hospital births.  As a Licensed Professional Midwife in the state of Oregon, I have a certain set of criteria, guidelines and protocols that I practice under.  OHP has taken some of these rules and regulations and added some of their own, most often stricter.  Sometimes it is clear as to what their rules governing prenatal care, birth, and postpartum and their risk factors are and sometimes it can get a little murky.  We practice and strongly believe in individualized care and informed choice which means our families get to make their own educated decisions about their care after we’ve talked about all the pros/cons and benefits/risks of any testing/screening/procedure.

However, for our clients with OHP some informed decisions aren’t as optional as they usually are.  This is really disappointing but for now, its a hoop our clients have to jump through if they have OHP and want their homebirth covered.  For most, OHP assumes that the standard screening for Gestational Diabetes and Group Beta Strep, among initial and mid-pregnancy blood work need to be done.  OHP also requires monthly chart notes and updates to prove our clients still remain low-risk and good candidates for homebirths in Portland.  As it stands right now, OHP will not approve someone for a home birth if they transfer into midwifery care after 28 weeks.

So, where does that leave us?  Well, Portland Natural Birth still remains committed to serving clients, regardless of their financial constraints and will continue fighting to get our OHP clients approved for a home birth.  I have also written letters to the Oregon Health Authority (they oversee OHP and the approval process for homebirths) in support of changing their prior-approval process.  OHP pays half of my midwifery fees yet requires more than double the paperwork and headache than any other insurance company does.  But, rest assured Portland families, while we are fighting for a more equitable process for midwife and pregnant homebirth client, we are taking OHP clients and happily giving them our love and support.  Its what we believe in and your insurance company doesn’t change that fact!

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