How One Florida County Offers Care For Every Pregnant Woman
Most county health department 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 Q-tips.
When Colson found out she was pregnant, she was already 10 or 11 weeks pregnant, 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.
There’s a reason things were quick. Well, not so much a reason as a person: Dr. Heidar Heshmati – his name is on this building in Rockledge. And he’s not shy bragging about the program he built 20 years ago.
“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. You read that right: 100 percent. Here, the safety net isn’t a net 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 for the last 20 years. 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.
As government employees, they can’t be sued if a birth goes bad. So doctors can see high-risk patients without the worry of big, multi-million-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; they divide the patients up.
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 doing that, the state of Florida will be the first state to have 100 percent coverage for the pregnant woman,” Heshmati said.
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 20 years ago and found a solution. And what was happening on the Space Coast 20 years ago is now happening in large parts 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 others fail because the counties will take bits and pieces of the program, and not the whole thing.
Take the three Florida counties who added prenatal care to their health department in the past three years: Pasco County, Bradford County and Union County.
Jennifer Pruitt is a certified nurse midwife for Gainesville OBGYN. That private practice gets a rent-free room to see Medicaid patients once a week at the Bradford County Health Department in Starke, about an hour north of Gainesville.
“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 ask for some of the women. 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.”
WMFE is a partner with Health News Florida, which receives support from the Corporation for Public Broadcasting.
Health reporting on WMFE is supported in part by Florida Hospital.