City Tightening Eligibility Requirements for Indigent Mothers
Policy shift made because of lack of resources, city officials say

By Erik Rodriguez
AMERICAN-STATESMAN STAFF
Friday, April 16, 2004

Future patients of Seton Healthcare Network will not have access to prenatal services through Austin's indigent health care system, and as a result, other agencies are gearing up for an expected rush of new patients.

The Austin Community Care Services Department, which runs 12 clinics around the city, recently changed its policy of accepting outside agency referrals for prenatal care. The city's existing patients, who include the poor and uninsured living in Austin and Travis County, won't be affected, administrators said.

Seton provides indigent primary care but not prenatal services. Seton officials said they did not know how many women would be affected by the change, but noted that they made 140 prenatal referrals in 2003 overall to several agencies, including the city.
Seton administrators say they'll have to turn to other sources, including volunteer doctors and nurses, to treat pregnant women. Other nonprofit groups that provide such services, including El Buen Samaritano Episcopal Mission and People's Community Clinic, said they're preparing for a deluge of requests for care, adding that there is a possibility that women will go untreated.

City officials said the change was a necessity and the latest example of an overburdened, underfinanced indigent health care system that has been pushed far beyond its limits.

"We have to start making hard decisions on how we prioritize who we're going to see first," said John Gilvar, a community care department spokesman. "We have to ask, at what point do we need to worry about our existing patients getting in?"

Each year, medical personnel at city-run clinics treat about 50,000 people, most of whom have annual incomes below the federal poverty level of $18,400 for a family of four. Those clinics already operate above capacity, and demand for care, including prenatal services, has increased dramatically in the past three years, Gilvar said.

The city reconsidered its policy last month after a $232,315 state grant to provide prenatal care ran out and practitioners observed that the city's regular maternity patients had trouble getting appointments. City officials informed Seton of the change in an e-mail on March 22, after a Seton patient was denied city prenatal services.

The new policy gives priority to women who qualify for services and either are current city patients or have no other health care provider, Gilvar said. The policy won't reduce the number of prenatal patients the city already serves, he said.

Seton has never offered prenatal services through its three neighborhood clinics because there wasn't an urgent need before now, said Diana Resnik, Seton vice president of community care.

Officials don't plan to add prenatal services, which typically include ultrasounds, blood work and exams, because they're focusing on primary care, she said.

"There's limited resources and lots of needs," Resnik said. "We're just now seeing this whole prenatal thing surface, so we've got to get creative and partner with our private doctors and see what we can do to at least patch this a little."

Resniksaid she thinks women who need prenatal care will still be able to receive it, though she added it was possible some women wouldn't be able to receive treatment because of the city's new policy.

Women with urgent needs still will be referred to Brackenridge Hospital for emergency care, Resniksaid.

The prenatal care problem is just one of several health care issues that members of the communitywide Indigent Care Collaboration, an advisory group that includes Seton, the city and several other agencies, are working together to try to solve, Resniksaid. The group recorded more than 19,000 visits to indigent care clinics by pregnant women in 2003, statistics show.

So far, the impact of the policy shift has been difficult to measure.
Seton patient Beatriz Romero, 22, said she had no problems finding room at El Buen Samaritano. Romero, who is three months pregnant, said she received prenatal services for this pregnancy through El Buen four times and has only one complaint.
"It's very expensive," said Romero, who does not qualify for reduced cost services through the city.

But the Rev. Ed Gomez, executive director of El Buen Samaritano, said he already has seen an uptick in requests for prenatal care, including four this week.
Gomez said his agency has already reached its capacity with 140 prenatal patients, although spots will open as women deliver babies. Those who don't receive care could be at risk for serious complications, which would shift the burden to Brackenridge Hospital, he said.

"This is highly critical, because if these women don't get proper prenatal care it's going to be devastatingly costly," Gomez said.

Officials at other agencies, including People's Community Clinic, also expect to see increases in requests for prenatal care.

Regina Rogoff, director of People's, said her agency's 60 to 70 pregnant women already are all it can handle. Without additional funding, the system's problems will continue, she said.

"We will try to help to the extent we can," Rogoff said. "We are partners with the city, but our capacity can only be stretched so far."