Most county health departments no longer offer services to pregnant women. But on Florida’s Space Coast, the opposite is true: The county health department offers 100 percent coverage for pregnant women.
Here, 21-year-old Briana Colson has just met with her obstetrician at the Brevard County Health Department. Ten days ago, she gave birth to twins.
“We were trying, but we weren’t trying for two,” she said with a laugh.
In addition to taking care of 10-day-old twins, she also has to take care of herself. She didn’t slow down and heal after birth, and her doctor loaded her up with a bag of peroxide, gauze and cotton swabs.
When Colson found out she was pregnant, she was already 10 or 11 weeks along, so she wanted to get in to see a doctor quickly. And having twins is always a high-risk pregnancy.
“They got me in quick, about a week,” Colson said.
Health News Florida is highlighting details of its Pregnant and Poor investigation all week. See the series here.
There’s a reason things were quick. Not so much a reason, but a person: Dr. Heidar Heshmati of Rockledge. And he’s not shy bragging about the program he built 20 years ago. His name is on the building.
“Our prenatal care, I tell you that, is No. 1 in the United States,” he said with a laugh.
Brevard County’s health department offers 100 percent coverage for pregnant women. That's right: 100 percent. Here, the safety net isn’t a net at all, it’s a floor.
“It means any pregnant woman, it doesn’t matter if they have money or not, if they are legally here or not, whatever. We are open to them,” Heshmati said. “That’s the only county where we have 100 percent coverage.”
How? Well, Heshmati developed a formula, and it’s brilliantly simple.
In Brevard County, almost every OB doctor is an employee of the health department. They get paid by the hour for seeing Medicaid and uninsured patients at the county health department and for delivering their babies. The whole maternity budget is $3.2 million.
Since nearly all Medicaid patients are now enrolled in private managed-care plans, those plans pay Brevard DOH under contract to provide the care.
As government employees, the OB doctors can’t be sued if a birth goes bad. So they can see high-risk patients without the worry of big, multimillion-dollar lawsuits or – just as likely – not getting paid for their services. They don’t have to handle billing Medicaid. And they don’t have to fight each other for Medicaid business.
Now, the program isn’t perfect. It’s run a little shy of cash a few times and had to ask for money from Brevard County government. But by and large, the 20-year-old program is touted as a national model.
“If everybody (were) doing that, the state of Florida will be the first state to have 100 percent coverage for the pregnant woman,” Heshmati said.
Instead, most county health departments in Florida do not offer prenatal care. And with a few exceptions, the ones that still offer it typically contract with one or two local obstetricians, not the majority of prenatal doctors in an area.
Some have described Heshmati as a visionary, a prophet even. Four cabinets in the health department are packed with awards for the county’s approach to prenatal care.
But Heshmati said he just saw what was happening in prenatal care in Florida and proposed a solution. He said what he saw on the Space Coast 20 years ago is now happening in the rest of the state.
Heshmati rattles off the consequences:
“So many patients without prenatal care,” Heshmati said. “They don’t know where to go. They don’t have money. No prenatal care. End up in hospital emergency room for delivery. Huge, huge malpractice.”
Like many people described as visionaries, Heshmati spends a lot of time preaching to other health departments. But he says others fail because the counties will take bits and pieces of the program, and not the whole concept.
For example, take the three Florida counties who added prenatal care to their health department in the past three years: Pasco, Bradford and Union Counties.
At the Bradford County Health Department in Starke, about an hour north of Gainesville, Jennifer Pruitt works as a certified nurse midwife for Gainesville OB-GYN. That private practice gets a rent-free room to see Medicaid patients once a week.
“So they’re really great, they give me a little cubby, so I have my own little cubicle and then we have our own exam room,” Pruitt said, showing off the room where she sees pregnant patients.
Here, they can do Doppler, listen to heart tones and draw lab work.
“I literally have a little command unit I bring with me,” Pruitt said. “[We can] even do post-partum birth control options.”
Joseph Pietrangelo is the administrator of the Bradford County Health Department. In this rural part of the state, most people work in agriculture, trucking, or for the prison system.
He said the women on Medicaid were having to travel to Gainesville for care, an impossible task for some of them. So he asked a private doctor to come from Gainesville to the county health department.
His big concern was what if everyone turned him down. He didn’t have a backup plan.
“The ideal situation would be to be big enough or rich enough to have an obstetrician on staff,” Pietrangelo said. “But we’re not big enough, we couldn’t provide the panel of patients to make that reasonable. And this is the next best thing.”