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Midwifery Support in States Leads to Better Birth Outcomes: New Report Offers Guidance for Improving Maternal Health in Medicaid

May 5, 2020

Midwifery Support in States Leads to Better Birth Outcomes: New Report Offers Guidance for Improving Maternal Health in Medicaid

Washington, DC - States that support autonomous midwifery practice have overall better birth outcomes, including lower odds of a cesarean delivery, preterm birth, and birthweight. Hospitals that incorporate midwives have a 74 percent lower rate of labor induction and a 12 percent lower rate of cesarean deliveries.

Based on the decades of data demonstrating that the midwifery-led model of care has comparable or improved outcomes when compared to care by physicians, the Institute for Medicaid Innovation (IMI), a non-profit, nonpartisan research and policy organization, has developed a comprehensive report containing critical information necessary for Medicaid stakeholders who are considering improving access and coverage for the midwifery-led model of care. The report provides information to support the development of a business case for the midwifery-led model of care in Medicaid and discusses the realities and challenges this model may face. The resource also highlights case studies with lessons learned as well as a check list for essential items to consider.

Dr. Jennifer Moore, founding executive director of IMI, noted, “as we release this report, the pandemic is bringing to the forefront the very issues this project was designed to address; never could we have anticipated such a need for attention to maternal health policy in Medicaid, particularly midwifery-led care at freestanding birth centers. COVID-19 is laying bare existing health inequities, the consequences of lack of health insurance coverage, as well as the limited capacity of existing birth centers, regulatory barriers and restrictive requirements for midwives.  This moment presents an opportunity to address these inequities and barriers and fully incorporate the midwifery-led model of care into the Medicaid program.”

Currently, 26 states plus the District of Columbia allow Certified Nurse Midwives to practice independent of physicians, while four states require physician supervision and twenty require collaborative practice agreements. Across states, there also exists a varying level of uniformity in requirements for safe operation of freestanding birth centers, including nine states that have no regulations or licensure requirements whatsoever.

Processes for licensing and obtaining appropriate credentials to contract with health insurers often proves a burdensome task, resulting in birth centers focusing their practice primarily on self-paying clients. Common contracting challenges may also include limits on the physical distance from an acute care facility, transfer agreement clauses, and unsustainable compensation for services. However, based upon the consistent evidence for the quality of care provided by the midwifery-led model of care, it is important to address these barriers.

Developing a maternal health initiative business case in Medicaid is a complex but achievable task, and IMI’s new report aims to provide guidance on how to successfully navigate this path. Alternative payment models (APM) are value-based payment (VBP) methodologies that incentivize providers to provide high-value care, and maternity care is considered an ideal candidate for the bundled payment option. Freestanding birth centers are currently exploring ways to ensure fiscal sustainability while serving the Medicaid population by bundling services and payment.

This report is available on the Institute for Medicaid Innovation website here, along with the checklist and graphics.


About the Institute for Medicaid Innovation

The Institute for Medicaid Innovation (IMI) is a 501(c)3 nonprofit, nonpartisan research and policy organization that provides independent, nonpartisan information and analysis to inform Medicaid policy and improve the health of the nation.


Media Contact

Lydia Tonkonow