Midwife Nichole Wardlaw speaks during a press conference at Virginia's Capitol to highlight survey findings of barriers to prenatal care for Medicaid patients. Charlotte Rene Woods / Virginia Mercury
The results of a survey commissioned by a state department shows that a majority of low-income pregnant people newly enrolled in Medicaid aren’t able to access prenatal care in a timely manner due to processing issues stemming from managed care organizations.
Managed care organizations are insurers paid by the state to provide Medicaid coverage, which is a federal and state health insurance program that typically serves low-income or disabled people. In Virginia, Medicaid is administered by the Department of Medical Assistance Services, or DMAS.
New Medicaid enrollees are handled by managed care organizations, or MCOs. DMAS commissioned the “secret shoppers” survey to test the efficacy of Virginia’s contracted MCOs.
“DMAS monitors the MCOs in many ways,” Mary Olivia Renter, a spokesperson for the department, relayed in a statement. “The Secret Shopper Survey served as an innovative addition to our many processes.”
It found that 95% of the nearly 2,000 survey participants were unable to set up prenatal care. Causes included reaching disconnected numbers, excessive hold times, or the numbers connecting to out-of-state providers.
The survey also concluded that the MCOs were not compliant with DMAS’ wait time standards. This means that pregnant people would also be unable to set up doctor appointments while waiting for the MCOs to process their applications.
As a new method of data collection and auditing, DMAS noted the limitations of the survey.
“The surveys assessed a small sample of providers for the timeliness of new patient appointments only, not overall access to an appointment,” Renter wrote. “Due to the nature of the Secret Shopper Survey, callers were unable to provide any personal information or details required for preregistration. This was stated as the most frequent reason cases were unable to be offered an appointment or schedule an appointment within the appointment standards.”
But the survey helped to highlight some concerns which, anecdotally, advocates and prenatal professionals said they have been hearing from people.
PUSH Maternal Health Coalition, a cohort of various advocacy groups, gathered at Virginia’s capitol on Tuesday to highlight the survey results. They also implored lawmakers and the governor to support legislation to enhance maternal healthcare access more broadly and to “hold MCOs accountable.”
“Our hope is that MCOs see this as an opportunity to advocate for legislation they may need to improve access,” said Kathryn Haines, the health equity manager with the Virginia Interfaith Center for Public Policy.
The Virginia Association of Health Plans, a lobbying organization that represents Virginia’s MCOs, said their clients asked them to respond to media inquiries on the matter. Representative Heidi Dix said that the organization and its members are “keenly aware of the need for overall improvements in prenatal care” and that they are “fully engaged” to address issues.
“This report and other analyses have identified a variety of factors placing a historic strain on prenatal care, the Medicaid program and the overall healthcare sector,” Dix wrote in a statement.
Still, the disparities hit close to home for several members of the PUSH Coalition Tuesday — particularly when it comes to Black maternal health.
Kenda Sutton-El, director of doula and maternal health advocacy organization Birth In Color, said the survey didn’t surprise her. Instead, it helped confirm what she’s personally seen both as a Black mother and a doula with Black clients.
“This just validated the experiences of many Black pregnant women who have tried to navigate the complex world of managed care organizations against a backdrop of significant disparities,” she said.
While studies and data show that negative health outcomes or mortality rates are higher when Black people give birth than white people, Sutton-El wants lawmakers and officials to think more critically about the systemic contributions to such data.
“Instead of saying Black women are three times more likely to die, we have to start using language like, the system is actually murdering Black women at three times the rate,” Sutton-El said.
Nichole Wardlaw, a midwife with the American College of Nurse-Midwives and the National Black Midwife Alliance, said requirements for implicit bias training when renewing medical licenses must be a legislative priority.
This year, a bipartisan effort to do just that cleared the legislature before being vetoed by Gov. Glenn Youngkin in May. With racial bias one component of negative health outcomes, Youngkin did more recently issue an executive order to reestablish a maternal data task force ( after vetoing a passed bill that would have done so as well ).
Stephanie Spencer, a nurse and founder of Urban Baby Beginnings, commended the governor’s executive action. The coalition said they hope to see the governor signing laws, issuing orders, allocating funding and voicing support for these issues more often.
“There’s still a lot of work that needs to be done, and obviously this survey shows that we need to do better,” Spencer said.
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