Access to Midwifery Care.

Do you believe all childbearing women should have access to midwifery care in the home, in birth centers and in hospitals?  Do you believe all midwives should be compensated for their services?  Now more than ever, we need to take action.

The Mission of the National Association of Certified Professional Midwives (NACPM) is to significantly increase women’s access to midwives by supporting the work and practice of Certified Professional Midwives.

As a professional organization, we are dedicated to maximizing the potential of the Certified Professional Midwife (CPM) credential, and the midwives who hold it, in order to increase the number of midwives available to adequately meet the needs of childbearing women. NACPM strives to ensure that CPMs will achieve their appropriate place in the delivery of maternity care in the United States

As Certified Professional Midwives achieve recognition of the CPM credential in state after state, the inevitable next step for many is third-party payment for services – especially government health care plans. The health care system in this country is presently a varied hodge-podge of government and private payment mechanisms, ranging from federal government plans such as Medicare, Medicaid, Tricare, and the Federal Employees Health Benefit Plan (FEHBP) – to private managed care to traditional insurance. From the perspective of CPMs and their clients, however, this vast and dysfunctional array of health payment mechanisms has one overriding attribute in common – for the most part, they do not cover home birth or the services of CPMs and, if they do cover birthing center services, they do not pay the facility fee. For many consumers, non-coverage of a service, however much that service may be desired, may result in lack of access. CPMs and state midwifery associations are repeatedly frustrated by the stone walls they encounter when they seek participating provider status, either from private managed care or state Medicaid plans.

CPMs and other direct-entry midwives do not have mandated provider status under federal law. State Medicaid plans may add non-mandated services, however, and midwives have convinced some state legislatures or Medicaid offices to include them as providers. As we know from the licensure struggle, it is a long slow process to achieve anything on a state-by-state basis. Presently, only Alaska, Arizona, California, Florida, New Hampshire, New Mexico, Oregon, South Carolina, Vermont, and Washington State include midwives other than CNMs within Medicaid. And the APHA presentation revealed that midwives other than CNMs are actually participating as Medicaid providers only in Florida, New Hampshire, New Mexico, Oregon, South Carolina, Vermont, and Washington.How can individual CPMs influence this process?

While NACPM may retain a professional lobbyist, grassroots support by CPMs and their clients is just as vital at the federal level as in your respective statehouses. Talk to your Congressman, Congresswoman, and your Senator about midwives and out-of-hospital birth. Send them the same birth announcements you send your state representatives. Get to know their staff members. This same education process which has worked so well in the state capitols is also needed here, so that your federal representatives will learn that their constituents want the choice of out-of-hospital birth with CPMs.Medicare and Medicaid Coverage of CPM Services
By Susan M. Jenkins, J.D.©


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