Pregnancy Services in Alabama

This week it was reported that many women in Alabama have to wait until the second trimester of their pregnancy before they are able to see a doctor for prenatal services. The wait is often caused by a delay in the bureaucratic process of determining eligibility. Before a woman is able to receive pre-natal treatment, many OBGYNs in the state require that a woman is enrolled in Medicaid. This causes many women to go without care until the state has approved their application. All states are required to process applications within 45 days. While Alabama does not provide a timeline of how long their application approval process takes, advocates have noticed that they often take longer than a month.


One major problem lies in how large of a problem this could be:

– Nearly 53 percent of births in Alabama are financed by Medicaid

– Only 75 percent of Alabaman mothers receive adequate prenatal care


While on average Alabama Medicaid asserts that 64 percent of Medicaid mothers receive prenatal care in the first trimester or within 42 days of enrollment, this doesn’t necessarily indicate that the level of care they are receiving is timely. If applicants aren’t approved for six weeks after their application this is already half way through their first trimester.


There may be an easy way to lessen Alabama’s problem.


The natural thought is that OBGYNs could accept Medicaid eligible patients while their application is under review by the state. However, this solution relies on the physician carrying the risk that the pregnancy will not be covered or that their patient would not apply for coverage, especially if there were a complex condition, requiring expensive treatment. While preventative service appointments that are at question here are low risk in terms of the financial stake of the patient not being eligible for Medicaid, the risk that OBGYNs may fear is that the patient would need sudden high cost treatment.


Since 1986, a policy known as presumptive eligibility has allowed states to enroll pregnant women in Medicaid through a seamless process. The goal of this policy is to allow pregnant women to get care while their application is under review.


Alabama is one of 19 states that have not extended presumptive eligibility to pregnant women. The policy is available to states to extend coverage to children and pregnant women across the state at all hospitals. A second more recent change to the policy has made presumptive eligibility available for hospitals to assume eligibility for all populations covered by the state’s Medicaid program. Prior to the passage of the Affordable Care Act, a hospital in Alabama that saw many pregnant women may not be reimbursed if a pregnant patient weren’t already enrolled in Medicaid. Now hospitals can elect to perform presumptive eligibility and presume low-income pregnant women would be eligible for Medicaid and provide seamless care.


Unsurprisingly, the American Health Care Act, that passed the GOP House contains a provision that ends the presumptive eligibility program. This provision has seen opposition from Republican governors in the past. To date there is little evidence that hospitals have taken up this policy in states or whether this policy leads to greater use or expense to states.


This is a policy with little research into its effect. But one possible impact could be that it influences the behavior of OBGYNs and could increase access to prenatal pregnancy services.


While most prenatal care is not provided in a hospital setting, it could ease the fears of OBGYNs that they would not be reimbursed for more costly care. OBGYNs affiliated with hospitals could ensure that patients have the attention and high quality care that necessary during pregnancy.


Hospitals in Alabama have the opportunity to reduce the problem created by the Alabama Medicaid agency’s failure to take up the 30 year old policy to provide care to pregnant women and the agency’s slow approval process. By hospitals enrolling in presumptive eligibility there is a chance that more women could see prenatal care and healthier babies will be born in Alabama.