The Perinatal Journey and how STRIDE is looking to support patients facing Institutional Challenges

STRIDE Health Centers do not deliver babies directly but work in partnership with Caring for Colorado to provide essential services to parents in the Denver metro area. STRIDE is dedicated to supporting parents as they reconnect with community health resources post-delivery, ensuring comprehensive care and a healthy start for their families. Additionally, STRIDE offers a Centering Pregnancy program available in both Spanish and English, fostering a supportive environment for expecting mothers through shared experiences and comprehensive prenatal care.

Recognizing the challenges parents face after labor, STRIDE is committed to offering the necessary support and resources to help them navigate this difficult time. Join us in supporting parents and ensuring they have access to the best possible care as they embark on their parenting journey.

Navigating labor and delivery in a hospital system has its challenges. There are multiple items pregnant patients have to account for when deciding to give birth in a hospital, especially insurance coverage, out-of-pocket costs, and their own health. These items along with additional factors such as race, ethnicity, language, socioeconomic status, citizenship, etc. can make giving birth in hospital systems quite different for some people especially among marginalized groups like low-income, Latinx parents to be.

In the United States, the average out-of-pocket cost for childbirth with health insurance is $2,854, but costs for vaginal birth are lower ($2,655) compared to cesarean birth ($3,214) (1). In Colorado, the average cost per birth with insurance in 2019 was $3,799. Within that same year, vaginal deliveries were less costly ($3,305) compared to cesarean births ($5,268 per birth) in Colorado (2). In addition, there are other factors that can influence out-of-pocket costs including whether a patient gives birth at an in-network hospital/facility, the type of birth, and additional services during labor (epidural etc.) (1). However, without health insurance, the national average for childbirth services in a hospital setting is $18,865 (1).

As seen above, giving birth in the United States and Colorado can be expensive, especially if a pregnant patient is uninsured. One way that low income, pregnant Latinx patients can access more affordable labor and delivery services is through Medicaid. In the United States, Medicaid financed about 41% of all births, and 35.1% of Medicaid covered births were Hispanic/Latinx (3). For Health First Colorado, a little more than 40% of all births in the state were covered by the state’s Medicaid program and 39.2% of those covered births were Hispanic/Latinx in 2019 (the largest proportion of births by ethnicity/race in Colorado) (2). Also, in Colorado that same year, 17% of births could not be matched by a birthing parent’s Medicaid ID with their newborn’s birth certificate, which might indicate that these unmatched members were more likely to be in the noncitizen emergency services eligibility category and more likely to self-identify as Hispanic/Latinx (2). Even with this insurance avenue for Latinx patients to afford labor and delivery services, low-income, pregnant, Latinx patients on Medicaid have a 28% higher rate of complications compared to than non-Hispanic white patients (4). This is also the case for Latinx patients with private insurance plans who have a 22% higher rate of severe pregnancy complications (4).

For Latinx patients who are recent immigrants, there are more barriers to accessing affordable healthcare (including labor and delivery services) and communicating health needs. Latinx immigrants are more likely to have limited English proficiency (LEP), be noncitizens, have lower household incomes, and/or be uninsured (5). Many experience challenges with accessing and using health care in the U.S. due to higher uninsured rates, affordability challenges, linguistic and cultural barriers, and immigration-related fears, all of which have negative implications for their health and financial security (6). These challenges are more pronounced for those who are likely to be undocumented and have a lower income. (6)

A solution to these barriers and any severe pregnancy complications that Latinx patients might experience could include services that offer patient support and navigation through nurse navigators such as the Nurse Family Partnership (7). Services that provide nurse and maternity navigators to high risk, low-income pregnant patients can help address social drivers of health, and provide emotional support for patients (7). These nurses bridge the gap between patients and healthcare systems by both helping patients navigate the healthcare systems and by serving as an advocate to ensure a patient’s preferences, needs, and values are respected (8). In addition, nurse navigators help connect families with any additional community or support services that they might need (8).

To further address issues with labor and delivery affordability in hospital systems, there have been government programs and policies developed to help pregnant low-income patients receive affordable and quality care. As discussed earlier, Medicaid through Health First Colorado has helped low-income, Latinx patients afford labor and delivery services. However, there are other Colorado programs that aim to help pregnant patients receive affordable health insurance and financial aid including (9, 10):

• Colorado Indigent Care Program (CICP) provides discounted healthcare services

• Emergency Medicaid Services (EMS) provides Medicaid to those who do not meet immigration or citizenship requirements of Health First Colorado

• Health Insurance Buy in Program (HIBI) is a premium assistance program for Health First Colorado

• Presumptive Eligibility (PE) gives temporary medical coverage right away

• Colorado Works (TNAF) provides additional financial services for low-income families

There is also a relatively new Colorado law called Hospital Discounted Care (HDC) that protects low to moderate income Coloradans from high healthcare costs (11). This law requires hospitals to screen all uninsured patients for eligibility for state programs including Health First Colorado and Children Health Plan Plus (11). Hospitals are also required to provide care at a discounted rate to anyone with a monthly household income at or below $3,037 per month for an individual or $6,250 per month for a family of four (11). However, some hospitals may provide discounts for households who have a higher income than those stated above (11). Even if a patient is insured, they can still ask to be screened for hospital discounted care and hospitals are required by law to fulfill this request (11). This law is meant to protect Coloradans by: requiring hospitals to establish monthly payment plans based on monthly income, requiring all communication is in the patients preferred language, limiting the actions hospitals or collection agencies can take against a patient, and not requiring a patient to be a US citizen or have a certain immigration status to receive discounts (11).  

Citations

1)     Rivelli, E. (2024, June 19). How much does it cost to have a baby? 2024 averages. Forbes. https://www.forbes.com/advisor/health-insurance/average-childbirth-cost/

2)     Colorado Department of Health Care Policy and Financing. (2021, September). Health First Colorado Maternity Report . Denver ; Colorado Department of Health Care Policy and Financing . https://hcpf.colorado.gov/sites/hcpf/files/Maternity%20Report%20-%20Sept2021.pdf

3)     Centers for Medicare and Medicaid Services. (2024, May). 2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health. Baltimore; Centers for Medicare and Medicaid Services. https://www.medicaid.gov/medicaid/benefits/downloads/2024-maternal-health-at-a-glance.pdf

4)     Blue Cross Blue Shield Association . (2021, September 21). How Race and Ethnicity Influence Maternal Health Risks. The Health of America | BCBS.com. https://www.bcbs.com/the-health-of-america/reports/racial-and-ethnic-disparities-maternal-health

5)     Hamel, L., Schumacher, S., Artiga, S., Pillai, D., Kearney, A., Presiado, M., Gonzalez-Barrera, A., & Brodie, M. (2024, January 18). Most Hispanic immigrants say their lives are better in the U.S.. but face financial and health care challenges: The 2023 KFF/LA Times Survey of immigrants. KFF. https://www.kff.org/racial-equity-and-health-policy/poll-finding/most-hispanic-immigrants-say-lives-are-better-in-the-us/  

6)     Nurse Family Partnership . (2023). Nurse-Family Partnership OVERVIEW GENERAL INFORMATION. Denver. https://www.nursefamilypartnership.org/wp-content/uploads/2022/03/Nurse-Family-Partnership-Overview-2.pdf

7)     Gourlay, K., & Doan, M. (2022, November 22). Maternity navigator Victoria Brown breaks down barriers to care. Blue Health Equity. https://www.bcbs.com/the-health-of-america/healthequity/how-maternity-navigator-victoria-brown-breaks-down-barriers-healthy-pregnancies/  

8)     UAB Medicine . (2024, July 3). Perinatal Nurse Navigation. UAB Medicine. https://www.uabmedicine.org/perinatal-nurse-navigation/#  

9)     Colorado Department of Health Care Policy & Financing. (n.d.). Programs for Pregnant People. Programs for Pregnant People . https://hcpf.colorado.gov/programs-pregnant

10) Long, W. (2023, December 14). How to have a low-cost childbirth in Colorado. Colorado Health Healthshare. https://colohealth.com/blog/low-cost-childbirth-in-colorado/

11) Colorado Consumer Health Initiative. (2024, June 11). Hospital Discounted Care. Colorado Consumer Health Initiative. https://cohealthinitiative.org/hospital-discounted-care/