EPIDURALS: Medicaid Wants to End Cash Payment Demands

      Following complaints from Medicaid beneficiaries treated at some Florida and California hospitals, HCFA Medicaid Director Sally Richardson has stepped in and ordered an end to up-front demands for payments for epidurals. In a recent letter to state health officials, who bear the responsibility of making sure hospitals understand their Medicaid obligations, Richardson said that the problem "is not just a concern, it is alarming," and explained that "[u]nder federal Medicaid law, deductions, cost sharing or similar charges are not permitted for Medicaid services furnished to pregnant women. Thus, a participating physician's demand for these additional payments would be in violation of the law."

No Cash? No Service.
      The New York Times reports that while officials are unable to pinpoint how many hospitals are violating the Medicaid policy, doctors and health experts say that some are requiring women on Medicaid to fork over hundreds of dollars in cash before they can receive an epidural. In some instances, Richardson said, anesthesiologists have requested cash payments for the epidurals -- going so far as to refuse checks and credit card payments. Patients who could not come up with the cash were given less effective pain relief. Although Richardson did not identify any of the offending doctors or hospitals, the California Department of Health Services found that anesthesiologists at Northridge Hospital Medical Center had required $400 in cash from Medicaid patients and that the hospital had a hand in collecting the money. Northridge has since ceased the practice, and the state later demanded that the hospital refund the payments to 114 women.

Underlying Problem: Medicaid Payments too Low
      The Times reports that in many states, anesthesiologists are pushing state lawmakers and Medicaid officials for increased Medicaid reimbursements, charging that the program's current payments are only 10% to 20% of the amount paid by private insurance companies. Larry Bodkin, executive director of the Florida Society of Anesthesiologists, said, "The Medicaid reimbursement rates are so dreadfully low -- the equivalent of $20 an hour for someone with 12 years of professional training -- that they discourage anesthesiologists from taking Medicaid patients." Nonetheless, Richardson said, hospitals have a responsibility to provide Medicaid beneficiaries with the same quality of prenatal care given to the privately insured (Pear, New York Times, 3/8).