By Rick Armon
Beacon Journal staff writer
Beacon Journal staff writer
Perhaps baby’s first word should be “Medicaid.”
Ohioans are turning more to the government-sponsored program when it comes to paying for births — likely the result of a poor economy and fewer moms having private insurance.
Medicaid payments represented 38 percent of total births in 2011, up 4 percentage points from 2007, according to a Beacon Journal analysis of the most recent data available from the Ohio Department of Health.
Meanwhile, births paid for with private insurance fell 5 percentage points to 46 percent. Self-pay and other categories make up the remaining ways to pay.
“We saw a rise in Medicaid births throughout the United States during that time and it was directly related to the economy — more people losing their jobs,” said Dr. Edmund Funai, chief operating officer at Ohio State University Health System and professor and associate dean at Ohio State University College of Medicine in Columbus.
Other factors include the state expanding the income eligibility for pregnant women to receive Medicaid, allowing pregnant women to receive assistance while going through the qualification process and Medicaid managed-care groups pushing prenatal care.
“The important factor is that people have coverage for prenatal care and childbirth,” said Amy Rohling McGee, president of the Health Policy Institute of Ohio in Columbus. “Whether it’s paid for by the private sector or the public sector is not as consequential as having a source of health coverage to pay for that care.”
A 2009 report by the George Washington University School of Public Health and Health Services and the Henry J. Kaiser Family Foundation found that Medicaid has become the nation’s largest payer of maternity services.
Medicaid paid for more than four in 10 births nationwide, the study noted.
Whether that trend continues or not depends on the economy, Rohling McGee said.
The shift to Medicaid has occurred in Ohio even as the number of births in the state drops. There were 150,784 births in the state in 2007, compared with 138,024 five years later.
While births declined, the number paid for with Medicaid climbed by more than 1,000 to 51,866. Meanwhile, the births paid for with private insurance fell by 13,312 to 63,200.
Both Summa Health System and Akron General Medical Center reported that they are not experiencing the statewide trend. The Ohio Hospital Association also said its members weren’t seeing that shift. Neither the hospitals nor the association could explain the apparent disconnect.
Race, age are factors
The Beacon Journal analysis showed that race and age play a big role in determining how a birth is paid for in Ohio.
White women are more likely to use private insurance (54 percent) as opposed to Medicaid (32 percent).
Black women are more likely to pay with Medicaid (66 percent) as opposed to private insurance (18 percent).
Asian woman are more likely to use private insurance (63 percent) as opposed to Medicaid (14 percent).
Hispanics are more likely to pay with Medicaid (41 percent) compared with private insurance (24 percent) and self paying (22 percent).
Negative trend?
The shift isn’t a positive trend for hospitals and their maternity wards because Medicaid, depending on the market, can pay as little as 50 percent or 60 percent of what commercial insurance will pay, Funai said.
Ohio already has seen many maternity wards close, mainly in rural areas.
“It’s fairly rare for obstetrics services, the mother part of care, to be profitable for any hospital no matter what the payer mix,” Funai said. “These are not big money-making services at all.”
It’s difficult to determine the actual cost for these Medicaid births because the majority of enrolled pregnant women in Ohio get their insurance coverage through a Medicaid managed-care plan. About 1.6 million of the state’s 2.3 million Medicaid consumers — including all enrollees that aren’t disabled or elderly — receive coverage through managed-care plans.
The state pays participating insurance companies a set payment each month to cover all the medical costs for enrollees. The insurance plans then negotiate contracts with health-care providers, including doctors and hospitals, to determine payments for services.
The state also provides what are known as “delivery kick payments” to Medicaid managed-care plans for each enrolled female who gives birth as an incentive to keep expecting mothers covered from prenatal care through delivery.
During the most recent state fiscal year (2013), Ohio made these incentive payments for 60,455 deliveries, with each payment averaging $4,794.71, according to a spokesman for the state Medicaid program. The total cost of the incentive program for state fiscal year 2013 was about $289.9 million.
Rick Armon can be reached at 330-996-3569 or rarmon@thebeaconjournal.com.
Beacon Journal medical writer Cheryl Powell contributed to this report.
