MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

2010 PEBB changes result in lost coverage for home birth

Despite assurances of “no changes to the current design of the healthcare plans” and after a decade of insured access to home birth with licensed midwives, Oregon women covered under the new 2010 PEBB Statewide Medical Plan now and with no prior warning receive zero insurance coverage for this choice in maternity care. Before 2010, when Regence BlueCross BlueShield administered PEBB, use of a licensed midwife for home birth was covered at 70%.

The loss in coverage comes as a major disappointment to the women, families and licensed midwives in Lane County who repeatedly asked for assurances by PEBB that the new 2010 plan would continue coverage at the same rate. Had PEBB provided proper notice of the upcoming change in coverage, women, families and licensed midwives could have responded.

Instead, women desiring home birth and related services (breastfeeding support, for example) are now finding this care excluded on page 43 of the new 2010 PEBB Handbook. What does this mean? Coverage for home birth services no longer exists for PEBB employees in most (all?) of the state. Many women have long-established relations with their providers and are (were) in the midst of receiving maternity care. They now must pay out of pocket or initiate care elsewhere. Certified nurse midwives are covered but they no longer provide home birth services in Lane County or in most other communities in Oregon.

The unexpected loss coincides with the March 2010 Centers for Disease Control National Health Statistics report showing a five percent national increase in demand for out-of-hospital midwife births from 1990 to 2006. Oregon demand was greater at a growth of 6.3%.  ABC News provided coverage.

Because home birth and postpartum services are more cost effective than any other combination of provider and location, it is difficult to comprehend how lost coverage squares with PEBB’s assertion that the 2010 plan will yield better results in terms of cost. Maternity care is one of, if not the most expensive components of health insurance plans. Removing this option for women yields increases for everyone.

According to Christine Olsen, Oregon State University Research Associate in an email:

“For each mother who is forced to switch from her licensed midwife to one of the in-hospital care providers, PEBB will be paying a minimum of $10,000 more for the pregnancy and birth.  Our estimate is that this change is going to cost PEBB at least $500,000 a year (but probably much more). Noteworthy: PEBB will pay for a $20,000 elective C-section; my midwife charges $3300 for all prenatal, postpartum and birth services.”

The Board and not the plan administrator, Providence Health Plans, determines what is and what is not covered and at what level. Let’s hope the Board acts in good faith as sole decision-maker and restores PEBB employees’ choices in childbirth at its upcoming March 16 meeting. Women, midwives and supporters will attend. If you are insured by PEBB please support continued choice in childbirth, regardless of whether or not you would make the same choices, by adding your name to the following online petition:


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