Medicaid rules block mom's treatment

SAN ANTONIO - When Shontae Minor and boyfriend Khristian Rohena learned she was pregnant with quadruplets, they followed their San Antonio doctor's advice and sought a selective fetal reduction.

The procedure would have eliminated two of the fetuses while they still were in her womb, raising the chances that the remaining two would survive and be healthy, according to medical experts. The doctor also advised Minor, 22, that her own health could be in jeopardy if she attempted to carry all four to term.

But a state worker told the couple - after they had already traveled to Houston for the procedure - that Medicaid wouldn't pay the $4,000 bill for the fetal reduction.

Fetal reduction for Medicaid patients like Minor, who qualifies because she is low-income, is caught up in the politics of abortion in Texas. Since the procedure is classified as abortion, federal rules apply: Medicaid will only pay in cases of rape or incest or if it's necessary to save the mother's life.

Now, the state-federal tax-funded health plan could end up paying $1 million or more to provide Minor's complicated prenatal care, which included six weeks of hospitalization, and care for babies. In Texas, Medicaid spending for births, including prenatal services and care for a baby's first year, amounts to $2.2 billion a year.

The possibility of appealing the denial of the fetal reduction was never presented to the couple, but, if they had asked, the state Medicaid agency well might have reversed its initial decision, a spokeswoman later said.

"While the policy on abortion doesn't include (risk to the fetuses), it also doesn't preclude us from looking at all the factors involved in this unique case," Stephanie Goodman, spokeswoman for the Texas Department of Health and Human Services Commission, wrote in an email. "Doctors and patients can and should question a decision they don't think is in the patient's best interest. I'm sorry that didn't happen in this case."

Two sets of twins

Minor gave birth to two sets of identical twin boys on Jan. 15 - 10 weeks early. The boys ranged in weight from 1 pound 15 ounces to 2 pounds 7 ounces.

On Jan. 25, one quad died of a staph infection at St. Luke's Baptist Hospital. A second one died Feb. 7 of a bacterial infection and meningitis.

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Medicaid rules block mom's treatment