This is a private practice. The owners and midwifes decide who they will take on as a client. This isn't a hospital where you just show up and have a baby. All these women join up early in their pregnancies to receive prenatals and all the medical needs they need throughout the 9 months. Very similar to an OBGYN. The medicaid cap was put on from strictly a business point of view. If you have clients with insurance who will pay you $5,000 or medicaid clients who pay half that. Which one would you do??? From a business standpoint they couldn't turn a profit if the majority of their clients were medicaid that simple. Not without firing staff and offering less services. Having a cap allows them to offer better quality service, employ more staff and turn a profit. It's simple economics. This is something that's happening all over the medical field especially as the people on medicaid rises. Being on medicaid means you won't get top quality service from many areas in the field.