What Does the New Health Care Law Mean for Birth Centers?

On March 23, 2010, President Obama signed historic health care legislation into law. What impact will the law have on birth centers, midwifery, and maternity care overall? The law contains several major provisions that signal positive change.

* A mandate of Medicaid payment for the birth center facility fee in the states and jurisdictions where birth centers are licensed
* 100% reimbursement of certified nurse midwife (CNM) services in Medicare Part B
* Separate payments to birth attendants "as recognized under state law as determined appropriate by the Secretary"
* Cesarean section, giving birth and domestic violence can no longer be considered pre-existing conditions and used to deny insurance coverage
* Guaranteed coverage for pregnancy
* Workplace protection for nursing women
* Guaranteed insurance coverage of mammograms for women
* Screening for postpartum depression
* A range of other preventative services such as screening for diabetes and heart disease

The Medicaid birth center facility fee mandate was the major legislative priority for the American Association of Birth Centers (AABC) and its members. AABC hired nurse-turned-women's-health-lobbyist Karen Fennell to lobby for this provision, which she was able to do successfully on a fraction of the budget of some of her fellow lobbyists. (Last September, the Associated Press ran a story about Fennell's low-cost but highly effective lobbying activities.)

But even with the health care bill signed into law, the struggle isn't over yet. AABC is now setting meetings with the Federal Medicaid director and the Medicaid directors of the individual states to discuss implementation of the law. The path to full implementation depends on how birth centers are licensed in each state. In Maryland, birth centers are licensed by the Department of Health and Mental Hygiene's Office of Health Care Quality, and are staffed by certified nurse midwives. So the environment for Medicaid payment of the birth center facility fee is in the most favorable of four categories of implementation. Since the Maryland is now getting its state funds matched by Federal funds, there may be an opportunity to seek additional funding.

Seasons of Life Women's Health and Birth Center will continue to monitor the changing environment for health care as we approach Opening Day in 2014.

Special thanks to AABC Legislative Committee Chair Jill Alliman for her legislative analysis.

Photo credit: Marvin Joseph for the Washington Post