Health Reform Action Center
Medicaid and Medicare Reimbursement
for Midwives and Birth Centers
Medicaid Payment for Freestanding Birth Centers
ACA ensures that State Medicaid Programs cover maternity care provided in freestanding birth centers and allows individual States to determine specific types of providers at these birth centers.
States are now required to reimburse the facility and the birth attendant(s) separately.
ACA does not specify birth attendants who may practice in freestanding birth centers. This is an individual State decision. States can, for example, include certified professional midwives (CPMs). State law governs the licensure and scope of practice of birth attendants who provide care in these facilities.
What States must do to Comply:
This requirement went into effect the day the federal law was passed (March 2010), unless a State did not license freestanding birth centers.
States that license freestanding birth centers must submit -- to the federal Center for Medicaid, CHIP and Survey & Certification (CMCS) - amendments to their Medicaid State plans that specify coverage for freestanding birth centers as well as separate reimbursement for facility services and professional services.
Prior to ACA, federal law required State Medicaid Programs to cover and reimburse for nurse-midwifery services. But federal law is clear that State law governs the scope of practice for nurse-midwives. Medicaid will pay directly for nurse-midwifery services as long as the conditions of the state practice act are met.
Medicare Payment for Certified Nurse-Midwives (CNMs)
ACA changed the federal rules on reimbursement to nurse-midwives under the Medicare program.
Medicare equivalent reimbursement:
Effective January 1, 2011, Medicare reimbursement to certified nurse-midwives (CNMs) is equal to the physician rate for the same billed services. Prior to 2011, CNMs were paid at 65 percent of a physician’s rate. (Note: Over half the States have laws mandating third party reimbursement for CNMs or have an ‘any willing provider’ law that accomplishes the same thing.)
ACOG supports reimbursement equity for CNMs at 100 percent of physician reimbursement.
Medicare payment bonus:
From 2011 to 2015, certified nurse-midwives (CNMs) whose primary care services account for at least 60% of their Medicare allowed charges will receive 10% Medicare bonus payments.