Thread: Immigrants’ prenatal care costs state 5 times the initial es

http://www.nwanews.com/adg/News/157835/

Immigrants’ prenatal care costs state 5 times the initial estimate
BY NELL SMITH

Posted on Saturday, June 17, 2006

URL: http://www.nwanews.com/adg/News/157835/


At $ 6. 5 million per year, a Medicaid program that pays for prenatal care for immigrant women is costing the state more than five times what officials predicted two years ago.

The unexpected higher cost stems from Medicaid officials underestimating the number of women who would qualify and failing to factor in the cost of prescription drugs and hospital stays after deliveries.

“I can’t imagine the department missing the target so far on cost,” said state Rep. Jay Bradford, D-White Hall. “And I’ll have to follow up with them on that as chairman” of the Public Health, Welfare and Labor Committee.

In April 2004, state Medicaid Director Roy Jeffus estimated the cost per birth for the new coverage would be $ 1, 300. However, prenatal care, delivery and postpartum care actually is costing around $ 4, 100. When introducing the coverage, Jeffus predicted the program would cost a maximum of $ 1. 3 million. In reality, the program cost $ 4. 3 million in 2005. In the first 10 months of fiscal 2006, which ends June 30, the state has spent more than $ 6. 5 million on the program. The federal government pays about $ 4 for every $ 1 Arkansas spends on the medical care.

“Most people require a hospital stay. Some people require some type of prescription drugs,” said Julie Munsell, spokesman for the state Department of Health and Human Services, which runs the state’s Medicaid program. “These are just routine things that weren’t factored into that price.”

“I can’t explain why that did not get factored in there,” she said. “Honestly, I cannot. It should have been.”

There was also greater than expected demand for the coverage.

Back in 2004, Jeffus also estimated the new coverage would apply to 800 to 1, 000 women. About 5, 832 women enrolled in the program between July 1, 2004 and June 30, 2005, with 1, 097 giving birth. The numbers increased the next year, with 8, 748 enrolled through April 30 this year and 1, 601 deliveries.

Munsell said the original estimate of 800 to 1, 000 women was a “best guess.”

In the first month of the program, July 2004, 81 women enrolled. Medicaid officials used that information to determine an estimated total for the year.

The agency failed to take into account that women, once enrolled, stay enrolled for the duration of their pregnancy.

Information about the potential demand for such services has long been available.

According to statistics from the state Health Division, the number of babies born in Arkansas to foreign-born women has exceeded 2, 500 as far back as 2000.

In 2003, the year before the program began, more than 3, 700 babies were born to foreign-born mothers.

Arkansas began the Medicaid prenatal care program in 2004 when the federal government allowed states to offer prenatal coverage for some immigrants whose immigration status disqualified them from the government health insurance for the poor.

Before that, illegal aliens and legal immigrants who had been in the United States less than five years could not receive Medicaid.

The new program covers immigrant women whose income is 200 percent or less of the federal poverty guidelines.

Arkansas and eight other states chose to offer the new coverage. Texas, with its heavy immigrant population, is the latest state to begin offering the coverage.

It follows California, Illinois, Massachusetts, Michigan, Minnesota, Rhode Island and Washington.

The program technically covers medical care for the pregnant woman’s fetus, which if born in the United States would be an American citizen.

Advocates for the Medicaid coverage argued that paying for prenatal care can head off potentially very expensive health problems for the infant the state would wind up paying for later.

While immigrant advocates praised the new policy, abortion-rights leaders voiced concern about treating a fetus as a person.

Other critics, such as lieutenant governor candidate Jim Holt objected to providing state-funded services to illegal aliens.

Health and Human Services Department spokesman Munsell said the unanticipated program cost will come from savings on spending that Medicaid would otherwise incur if prenatal care were not provided.

She could not show reductions in other areas of Medicaid because of the prenatal care program.

“It’s difficult to know down to a penny how much you’ve saved,” she said.

So far, it is unclear whether the Medicaid coverage is actually decreasing the rate of immigrant women in Arkansas delivering babies without any prenatal care.

Prenatal care statistics by the mother’s ethnicity are only available through 2003, the year before the program went into effect.

The data is not available by immigration status.

Statewide, for all births, the percentage of mothers receiving prenatal care beginning in the first trimester, has declined slightly in the past few years, from 80. 2 percent in 2003 to 78. 6 percent over the first four months in 2006.

That means a smaller percentage of all pregnant women in Arkansas are receiving early prenatal care.

In each of the past three years, about 30, 000 of the 38, 000 mothers who gave birth received early prenatal care.

Some health-care providers say the program is significantly reducing the number of pregnant women getting no prenatal care.

Before the program began, uninsured immigrant women could either obtain prenatal care from a Health Department clinic, a charity clinic or a private doctor who agreed to provide services for free or reduced cost.

Hospitals cannot turn away women who come to an emergency room while in labor.

“Our walk-ins — people who come to labor and delivery without any prenatal care — has diminished dramatically. We’re talking from hundreds a year to a few per week,” said Dr. Scott Bailey, an obstetrician in Johnson, outside Fayetteville.

In Northwest Arkansas, where Health Department resources couldn’t meet demand for services, local providers struggled for years to find a way to treat the growing number of uninsured immigrants.

A community health center in Springdale signs women up for the Medicaid program, does basic testing and refers them to a private physician working on a rotating basis.

In 2005, the Washington County health unit saw 315 Hispanic women for initial prenatal care visits, and between March of 2005 and March of 2006, the Springdale health center referred 867 women to doctors for prenatal care.

Information about the immigration status of these women was unavailable.

“The physicians, even though they were going to see [immigrant women ] for free, now they’ve got a little bit better taste in their mouth about the thing because they are actually getting reimbursed,” Bailey said.

“Over a third of our deliveries are for indigent care,” he said, “and [we’re ] glad to do it.”

Tax dollars at work.

These people obviously have a problem with the word illegal

The solution to this problem is very simple. We need to check the legal status of anyone requesting or requiring medical care. If they are found to be illegal, place them on the next flight to a hospital in their home country. I'd rather see me tax payer dollars spent that way (one time spending) vice the continued care of the woman and her children.

There was also greater than expected demand for the coverage.

Yet another shocker!

Give something to illegals for free, and they use more of it.

Somebody ought to take note of that.