There is no shortage of evidence to show that birth centers and midwives provide care that is of at least equal or even better quality than that of hospitals and physicians, yet midwives are not reimbursed equally to physicians. Midwives are reimbursed less than physicians, for providing the same care. Yes, you read that correctly. Midwives are not being recognized or reimbursed fairly or adequately.
But why? It is certainly not because midwives provide lesser quality care. It is not because birth center care is more costly either. In fact, giving birth in a birth center is significantly LESS costly than giving birth in the hospital, due to the low-intervention nature of the midwifery model of care that avoids unnecessary monitoring, medications, and extended stays for birthing people. What makes birth expensive for payers is typically what the birth center avoids— here we have no epidurals, no cesarean sections, and clients go home a few hours after giving birth, eliminating the costs associated with unnecessary interventions and “room and board” so to speak.
Despite these obvious cost-savings, many insurance plans, including those under Medi-Cal, tailor coverage to prefer physicians and hospital births, effectively eliminating out-of-hospital care as an option for many. In the United States, birthing people face unequal access to birthing options and the birth rate for the country is rapidly declining.
Physicians are not reimbursed more because they are more expert on birth, either. Certified Nurse-Midwives are advanced practice registered nurses, meaning they have earned graduate degrees in nursing, specialized in midwifery, and passed several certifications and licensures, making them experts in the field of midwifery. Midwives are highly trained and educated individuals.
Plain and simple, the fact that midwives are not reimbursed equally to their physician counterparts is an inexcusable inequity. If midwives are not recognized and paid fairly, they are limited in the impact they can make in the community. Unfortunately, this inequity in reimbursement only perpetuates other inequities in the maternal health sphere too, as midwives are known to work with underserved and marginalized populations.
Medi-Cal currently reimburses midwives and birth centers 10% less than physicians and hospitals. AB-97, a budget bill passed in 2011, reduced Medi-Cal payments to all providers and facilities by 10%, due to budget constraints in the state. In 2017, this reduction was reversed for physicians and hospitals, but NOT midwives and birth centers. In order for midwives and birth centers to see the same reversal, additional legislation, specific to midwives and birth centers, has to be introduced.
The recent SB-65, also known as the California “Momnibus” Act, authored by Senator Nancy Skinner includes several points that seek to improve maternal health for Californians through improving maternal data collection, increasing benefits to pregnant people, and expanding funding to midwifery education programs. Without equitable reimbursement for midwives though, this act cannot make its full impact.
Help us continue to ensure that all pregnant people have access to the birth care and GYN care that fits them best. Contact your local legislator and let them know you stand with midwives and support equitable reimbursement.