Midwives: Pending legislation about choice

May 3, 2005

DAWN De BUSK/Frontiersman reporter

If the Senate and House finance committees refuse to hear bills that would allow Denali Kid Care to cover birth center fees, the state will lose a chance to cut its Medicaid costs, according to a staffer of the senator who introduced the legislation.

"We're missing out on the opportunity to give people more choices and save the state a big chunk of change," said Richard Benavides, chief of staff for Sen. Bettye Davis, D-Anchorage.

Senate Bill 22 and House Bill 111, which would add birthing centers to the list of health facilities covered by Medicaid, could have two advantages: savings to the state, and more freedom for child-bearing women.

About 85 percent of the patients of Valley midwife Holly Steiner are covered by Denali Kid Care. One of her clients, a single mom, not only has no income, she has no home.

"An at-home birth is out of the question because she's living in someone else's home. So she had to cough up the money to use the birthing center. She's the reason why this bill needs to be passed."

Steiner said birthing centers cost one-third of what hospitals costs, based on the facility fee alone.

The savings would occur because the price of having a child at a birth center is lower, Benavides said.

For example, the facility fee at Central Peninsula General Hospital in Soldotna ranges between $5,000 and $7,000, while it costs $1,200 to use Frontier Midwifery in Soldotna, he said.

"I'm just one committee away from it being voted upon," said Davis, adding that she's pushing to get it heard before the Senate Finance Committee.

Even if the bill isn't heard, Davis said she could pick it up in January when the next legislative session starts.

Currently, the state reimburses midwife fees of women on Denali Kid Care, but the facility fee must be paid by the patient. With most Medicaid programs, the federal government matches the state portion of funding, reimbursing 51 percent of medical bills.

Denali Kid Care is an enhanced program, with the federal government footing 71 percent of the bill.

However, the federal budget concerns some legislators.

Sen. Lyda Green, R-Mat-Su, said a passage of the bill would put strains on the Medicaid budget.

She said she also didn't want to set a precedent.

"It's a huge implication if the state starts implementing its own 100 percent Medicaid reimbursement. There will be people lined up, saying: 'You did it for them, you didn't do it for us,' " Green said.

A hearing for the bill hasn't been scheduled yet because the Senate Finance Committee, which Green co-chairs, has been too busy with the budget, she said.

The amount of savings would depend upon how many Denali Kid Care participants used the less-expensive birth centers over hospitals, but at least the option would be there.

"This bill would give low-income women another option for birth. More and more people are going toward less intrusive, more comfortable settings for giving birth," Benavides said.

"That's a milestone in your life. It should be a good memory," said Jessica Dassow of Palmer, who had her son, Kaleb Gary Dassow, in February at a Mat-Su birthing center.

"You should walk away saying, 'That was the best experience I've ever had.' I wish that for every woman," she said.