Lawmakers hear proposed solutions to address maternity care deserts

CHEYENNE – State lawmakers discussed the possibility of adding doula services through Medicaid and ideas proposed by the governor’s task force in their continued conversation on ways to address maternity health care deserts in Wyoming on Thursday.

On the first day of their two-day meeting in Cheyenne, members of the Legislature’s Joint Labor, Health and Social Services Committee spent the afternoon continuing their discussion on maternity health care deserts, which is listed as the committee’s No. 1 topic for the interim.

It was noted in the committee’s last meeting that this topic is complex and needs further investigation – likely to continue in the 2025 interim.

However, the committee is about to experience some serious turnover, with only four original members returning in the new year. Both its chairman, Sen. Fred Baldwin, R-Kemmerer, who announced he isn’t seeking reelection, and Rep. Dan Zwonitzer, R-Cheyenne, who lost his seat to Ann Lucas in the recent primary election, are among those who won’t be back in 2025.

Other members who won’t be returning are Reps. Forrest Chadwick, R-Evansville; Ben Hornok, R-Cheyenne; Kevin O’Hearn, R-Mills; Tamara Trujillo, R-Cheyenne; Jeanette Ward, R-Casper; and Sen. Anthony Bouchard, R-Cheyenne.

This was the committee’s first meeting since the primary election, but the robust afternoon conversation with task force members and state agencies continued business as usual.

“There is no bill, as I recall, this is a discussion,” Baldwin said. “For those who will be remaining on the committee, or who will be remaining in the Legislature, this is a topic you are going to learn about, and will be discussing in future sessions in future interim.”

Doula services in Medicaid

Representatives from the Wyoming Department of Health told lawmakers doula services can be covered through Medicaid and are eligible for matching federal dollars. This is already the case in 12 other states and Washington, D.C., said WDH State Medicaid Agent Lee Grossman.

“It is a growing trend that those of us in Medicaid hear about from other states, in terms of their analysis of this benefit,” Grossman said.

WDH senior policy analyst Franz Fuchs said adding doulas as Medicaid providers is going to require both a change in statute and an allocation in general fund dollars. The estimated cost to the state for adding this service is approximately $300,000, Fuchs said, which would be matched by the federal government.

An estimated 10% of Medicaid moms may opt in for doula services, but this is on pure assumption, Fuchs said, since “we don’t obviously have claimed experience.” This would be equivalent to 180 deliveries and an approximate reimbursement of $1,500 per birth for doula services.

There are some benefits to doula services, Fuchs said, such as a shorter length in labor, higher Apgar scores for the baby and higher likelihood of the mother to initiate breastfeeding.

“These are all relatively pro-social outcomes,” Fuchs said. “However, there's nothing that could indicate there’d be offsets, from a Medicaid standpoint, that could, say, pay for that service. So, we’re assuming 100% and no (return of investment), per se.”

Ultimately, there were no significant economic benefits to employing doula services, Fuchs concluded. Nor were there any reports of significant reductions in cesarean sections or anesthesia, he added.

“Particularly the benefits back to Medicaid would be very small and speculative,” Fuchs said.

Residency programs, risk monitoring

Members of the OB subcommittee of the Governor’s Health Task Force also presented a few updates on their findings to the committee. Task force members identified three primary challenges of maternity health care in Wyoming: limited health care workforce, geographic disparity and sufficient demand for OB-GYNs.

Out of the several proposed solutions the subcommittee came up with, there were three that Wyoming Medical Society Executive Director Sheila Bush, who serves on the subcommittee, told the Wyoming Tribune Eagle she felt strongest about.

The first is to add an OB fellowship and/or OB track at the Cheyenne Family Medicine Residency Program, or create a state-sponsored resident family practice/OB fellowship out of state. The idea is to turn out more providers who are certified in both family practice and OB services, Bush told the WTE.

“There's a lot of parts and pieces that have to come together to stand up an OB fellowship, but a track is pretty easy,” Bush said, adding that the Casper residency program already has an OB track.

Rural settings mean low demand for OB-GYNs, Bush said, which makes it difficult for communities to keep these providers. Widening their range of service to include family practice would increase local demand for that provider.

“In some of our smaller communities, we don't have enough patient volume to attract an OB,” Bush told the WTE. “If those physicians come out (of residency programs) comfortable with OB, they can move into communities and be FP/OB.”

Another idea is to adopt a risk stratification model similar to one in Alaska. This program would monitor risk levels of expecting mothers during prenatal care. If a mom is projected to be in a high-risk category by 32 or 34 weeks in her pregnancy, she could be temporarily moved closer “to an area where more, higher level services are available,” Bush told the committee.

A life flight for a mother in an emergency situation costs the state approximately $70,000 to $90,000 in Medicaid per trip, said Dr. Jaquez Beveridge, an OB-GYN at Cheyenne Women Clinic.

The third proposal is one that’s still being fleshed out, Bush said, but would basically create a mobile team of physicians to travel around the state. These teams would be deployed to different regions where high-level care is needed.

Team members would be licensed physicians that are still active in their fields, but aren’t working full time or are recently retired, Bush said. However, the selection of these physicians is still being worked on.