Midwives question insurance rates as birth centers ramp up
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Massachusetts stands to get more birth centers in the next year, but midwives and doulas will struggle to scale up their work without more funding, their advocates say.
Why it matters: Massachusetts, like much of the nation, lags behind other developed countries when it comes to safe pregnancies and births.
- The risks are often worse for Black and Latino people in a state where they were twice as likely to die while giving birth as their white counterparts, per the state's 2021 maternal mortality report.
The big picture: Birth centers have re-emerged in Massachusetts as a cheaper, more intimate alternative to hospital delivery rooms, especially among pregnant patients who say their concerns aren't heard in hospitals.
- A federal 2018 study and subsequent reports found that birth centers and deliveries with midwives lead to fewer C-sections, fewer premature births and fewer infant hospitalizations.
- But their ability to cover costs is uncertain if they don't see higher reimbursement rates from insurance plans, some health care leaders and advocates say.
Catch up quick: The 2024 maternal health equity law created a path to license certified professional midwives, which will go live once the state finalizes its regulations.
- The law also makes MassHealth reimburse certified nurse midwives, who are already licensed, at the same rate as doctors for the same work.
- Midwives say commercial plans reimburse them at 85% of a doctor's rate in hospitals for the same work, and less elsewhere.
- The Massachusetts Association of Health Plans says that's because even in a hospital setting midwives don't have the same education level or scope of practice as doctors.
State of play: Massachusetts' lone independent birth center, Seven Sisters Midwifery in Florence, has waitlists but is struggling to stay afloat largely due to low reimbursement rates, the State House News Service reported.
- The Cambridge Health Alliance plans to reopen its birth center on July 6.
- The Neighborhood Birth Center in Roxbury plans to open next year and eventually perform up to 300 deliveries a year.
- The center's executive director, Nashira Baril, is trying to raise $3.5 million, in addition to the $6.5 million she's raised, to make that happen.
What they're saying: Birth centers will rely on philanthropy to cover over half of operating expenses without any changes to reimbursements, said Nashira Baril, the center's executive director.
- "That's not a sustainable way to provide life-saving health care."
- Baril, advocates and lawmakers, including Sen. Liz Miranda, are pushing for a bill by state Sen. Joan Lovely to make commercial plans reimburse midwives at the same rate as doctors for the same work, one of several changes they're pursuing.
The other side: Lora Pellegrini, the MAHP's president and CEO, said midwives follow a different clinical model and serve a smaller patient population, often in a different setting.
- "As a result, reimbursement is not, and should not be, treated the same as hospital-based care," she said in a statement.
What we're watching: Construction is set to start on the Roxbury birth center this summer.
- The construction costs are covered, but Baril expects she'll need to do "evergreen fundraising" if things don't change.