12,500 Women May Lose Prenatal Care

Under a proposed state budget cut, 12,500 Georgia women may lose Medicaid coverage for prenatal care --- and for the delivery of their babies.

In the past five years, more Georgia mothers than ever received vital prenatal checkups through Medicaid because the state expanded income qualifications for the program, which overall covers 1.4 million low-income residents. Medicaid pays for nearly half of all births in Georgia. In 2002, about 64,000 of 133,000 newborns in Georgia entered the Medicaid system.

Now, Gov. Sonny Perdue, squeezed by a state revenue slowdown, has proposed rolling back Medicaid coverage for pregnant women who are not the state's poorest, but who will struggle to find affordable health insurance.

Today, patient advocates, medical providers and others are expected to jam a House committee hearing room to protest the proposed Medicaid eligibility cuts, along with other reductions in that program and changes to PeachCare, which covers uninsured children.

Other Medicaid budget cuts would pare benefits for adults, including emergency dental coverage and prosthetic devices such as artificial limbs.

The proposed shrinking of eligibility --- which would save $17.6 million --- is among $100 million in cuts for the Medicaid and PeachCare programs in the fiscal 2005 budget.

Under the Perdue plan, pregnant women and infants in households earning $34,040 or more for a family of four would no longer qualify for Medicaid. The Perdue plan reduces eligibility from 235 percent of the poverty level --- $43,240 for a family of four --- to 185 percent of the poverty level.

"This is an astonishingly bad change in public policy," said Linda Lowe, a consumer health advocate. "The very idea of denying expectant mothers access to prenatal care and safe deliveries is a giant step backward from the direction we ought to be going."

Women in the income bracket targeted for the cut who are pregnant and getting prenatal services before July 1, when the change would be implemented, would lose Medicaid coverage on that date, the state says.

So the family would then have to pick up the ongoing cost of prenatal and maternity services, unless they could afford and obtain private insurance. Or the hospital and physician would have to absorb the cost. 

Even an uncomplicated delivery, including doctor fees, can run at least $5,000 for the privately insured. And people without insurance often pay higher rates than those with coverage. In line with others Perdue's press representatives note that the reduction of eligibility would bring Georgia down to the same income level as other Southeastern states. Loretta Lepore, a spokeswoman for Perdue, said:

"There's some pain going to be felt across the state. But we're trying to cover the state's neediest families. We want to ensure the state's neediest families are receiving health care."

Routine prenatal care is considered crucial for the health of both mother and child. Premature babies, low-birthweight babies, and even death of the fetus can occur without it. And "high-risk" women suffering from diabetes, high-blood pressure and other medical conditions require even more medical attention.

For some women, good, consistent prenatal care can mean the difference between life and death for both mother and child, said Emily Kahn, chief epidemiologist for the Division of Public Health's maternal and child health office.

Nineteen-year-old Chatney Russell is one of the 70 to 100 women receiving prenatal care on any given day at Atlanta's Grady Memorial Hospital. Most receive Medicaid benefits or are enrolled in the "Grady Healthy Baby" plan that charges a flat $1,000 fee for prenatal care.

Russell, who is three months pregnant, lives with her family and doesn't know whether she would be affected by the proposed cuts. But she knows the care she and other Medicaid patients are receiving is vital to their babies' health.

"I'm learning about the growth of the baby and my health and what I should and should not do --- no alcohol, no smoking --- and what I should and should not eat," said Russell. "They also found out I had an irregular heartbeat, so they're monitoring that."

Insurance options are limited for lower-income pregnant women who don't qualify for Medicaid. Pre-existing condition

Even if a family could afford to buy an individual insurance policy, insurers likely would exclude coverage of a pregnancy as a pre-existing health condition, said Bill Custer, a health insurance expert at Georgia State University. "That income bracket is where a lot of uninsured are. They don't have access to group insurance or can't afford it."

If the family can't pay, the cost of the uninsured deliveries would be borne by hospitals --- and later, by taxpayers, through higher local and state taxes, and higher insurance premiums for those with private coverage, Custer said.

Funding shortfalls have led 49 states to implement or propose Medicaid reductions in the current fiscal year, a new survey by the Kaiser Commission on Medicaid and the Uninsured, a Washington-based research organization, found.

The Washington-based Center on Budget and Policy Priorities said an estimated 1.2 million to 1.6 million are being dumped from states' public health insurance programs --- many of them children.

Copyright 2004 The Atlanta Journal-Constitution