Medicaid covers the cost of nearly half of all Kentucky births. But it pays nothing for certified professional midwives who help moms give birth at home instead of in a hospital. Sen. Shelley Funke Frommeyer wants to change that.
On Tuesday, the Senate Families and Children committee unanimously approved Funke Frommeyer’s Senate Bill 89, which requires state Medicaid coverage of certified professional midwifery services. The bill has bipartisan support from lawmakers eager to expand birthing options for low-income families.
Sen. Cassie Chambers Armstrong (D-Louisville) is a co-sponsor of the bill. She told the committee today it is a “wonderful bill” that will save lives, citing statistics that 90% of maternal deaths from pregnancy are preventable.
“The reason they’re preventable is not because we need fancy interventions or more high-tech care, but we just need basic access to care, and I believe this bill would do that. I’m proud to vote yes for it,” Chambers Armstrong told the committee.
SB 89 could potentially increase 32-fold the number of Kentucky midwives with Medicaid-covered services based on the number of certified professional midwives in the state now. Only services of certified nurse midwives (or nurse practitioners) are now covered by Medicaid. However, there is only one certified nurse midwife providing care in Kentucky currently, compared to 32 certified professional midwives not covered by Medicaid, according to the grassroots Kentucky Birth Coalition.
Nationwide, Medicaid programs in 36 states don’t cover certified professional midwife care according to 2023 data from the federal Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission.
Expanding Medicaid coverage to certified professional midwives who “attend the vast majority of planned home births in Kentucky” would improve access, especially with a lack of freestanding birth centers in Kentucky, says the birth coalition. Birth centers are not addressed in SB 89.
“With there currently also being no freestanding birth centers in the state, hospitals remain the only choice for most birthing Kentuckians who wish to utilize their Medicaid coverage,” the coalition wrote recently. “This leaves many Kentuckians with extremely limited options for childbirth.”
“We need something that offers a midwifery model that is holistically healthy, and very focused on the wellness of the mom,” Funke Frommeyer said of the legislation last year.
Freestanding birth centers are midwife-serviced health facilities that allow women to deliver their baby and receive postpartum care outside of a hospital or private home. Nationwide, there are more than 400 freestanding birth centers in 40 states, according to the American Association of Birth Centers.
Although technically legal in Kentucky, there are no freestanding birth centers in the state. The state’s certificate of need law requiring state approval for new or expanded healthcare facilities has been cited as a reason.
Funke Frommeyer sponsored legislation last year to exempt the freestanding birth centers from Kentucky’s certificate of need requirements. That bill (SB 67) received committee approval but didn’t become law. This year, she is trying again with SB 103.
Should it become law, SB 103 would exempt birth centers with four beds or less from certificate of need in Kentucky. It would also allow hospitals to own or operate the centers (or not) with liability for care “limited to their own negligent acts and omissions that violate their standard of care under existing law.”
The bill wasn’t on the agenda of the Senate Families and Children committee when its meeting started Tuesday.
Hospitals have opposed removing freestanding birth centers from certificate of need requirements in past sessions. High-risk pregnancy has been cited as one drawback of the centers. So are complications during pregnancy, including issues that may require a cesarean or C-section delivery.
Approximately six percent of women receiving care at birth centers have a C-section after being transported to a hospital, the New York Times reported in 2018.
St. Elizabeth Healthcare physician Dr. Allana Oak told a legislative committee last fall that “catastrophic things can happen during childbirth” when a mother is transferred from one facility to another, the Kentucky Lantern reported in 2023. On Tuesday, St. Elizabeth Healthcare told LINK nky in an email that while they are “neutral on SB 89” the same is not true for freestanding birthing centers
“St. Elizabeth can only support initiatives which preserve the lives of all mothers and babies and do not place them at unnecessary risk,” St. Elizabeth said in the email.
As for SB 89, it could come to a vote on the Senate floor later this week. Funke Frommeyer told the committee before it unanimously approved the bill Tuesday the bill is about care “that feels beautiful.”
“If having a woman with you, who is a licensed midwife, you achieve the birth of a child successfully, that feels beautiful to your mind, your body, and your spirit,” said Funke Frommeyer.
Expanding Medicaid coverage to more midwives could also save Kentucky money, she said. “Cost may be dramatically reduced from what our taxpayers are currently helping to support through the Medicaid process,” said the senator.