In June 2013, the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) submitted its report to Congress. The report illustrates why use of a midwife will likely become an even more important component of America’s health care system.
Medicaid and Midwives
The American College of Nurse-Midwives (ACNM) praised the report for demonstrating the need to expand Medicaid coverage of midwifery maternal care. According to the ACNM, rising costs, reduction in the number of OB/GYN physicians and women’s increased use of midwifery are important realities. However, significant barriers to Medicaid coverage for midwives exist. These include “lower Medicaid payments relative to obstetricians/gynecologists in many states; hospital privileges/policies regarding non-physician providers practicing in inpatient settings; and state scope of practice laws,” according to a press release on the ACNM website.
The ACNM reports that, under current Medicaid guidelines, states must provide maternity services to women below 133% of the federal poverty level but have the discretion to expand coverage. In 2010, the CHIP and Medicaid programs funded 1.8 million hospital births, nearly half of the nation’s total. Medicaid provides more comprehensive and, thus, more expensive coverage for childbirth-related services.
The Patient Protection and Affordable Care Act (ACA) mandates “maternity care for those covered by health care exchange plans and requires coverage of other pregnancy-related services,” and raises the poverty level eligibility to 138%. The sheer volume of increased Medicaid coverage for maternity services coupled with the decrease in physicians and hospitals providing obstetrics in some areas will create a gap in care services that midwives can fill.
Midwifery Becoming More Acceptable
In the areas that lack obstetricians, family doctors have been working to fill the gap, but they are cutting back as well. Midwife services have thus increased from 7.8% in 2000 to 8.4% in 2010, reports ACNM, and this growth will likely continue.
There are advantages in using a midwife, says the American Pregnancy Association. These include lower cost, reduced interventions and, thus, less mortality and fewer complications. The report also cautions that complicated pregnancies may need more skilled obstetric intervention. Interestingly, New Mexico has both the highest rate of midwifery and the lowest number of C-sections in the nation, says a Time: Health and Family article from last June. Midwife-staffed birthing centers located near hospitals give peace of mind if an emergency arises, according to the Time article.
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