Giving birth at home with help from a trained midwife would be an option for more Kentuckians under a bill that has passed the Kentucky Senate.
Sen. Shelley Funke Frommeyer (R-Alexandria) sponsors Senate Bill 89, passed 34-3 on Thursday. The bill would make home birth available to more women by allowing Medicaid reimbursement for licensed, certified professional midwives who help with the majority of Kentucky’s approximately 384 annual home births, said the senator.
There are 32 certified professional midwives in Kentucky now, compared to only one or two nurse midwives. However, only nurse midwives – who are also state-licensed nurse practitioners – are currently allowed to receive Medicaid reimbursement from the state.
Fourteen states now allow Medicaid coverage for licensed, certified professional midwives, according to 2023 data from the federal Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission.
Home-birth assisted care under SB 89 would not include induced labor or epidurals commonplace in a hospital setting. It would include what Funke Frommeyer called “primary, comprehensive maternity care” delivered by a midwife from the prenatal period through labor and delivery to up to six weeks after birth.
“How does a holistic, physiologically natural process strengthen your mind, your body and your spirit? With a woman with you, known as a midwife, guides you, trains you, leads you through the path of giving birth with your own strength – your success leads to greater control and understanding of your own health,” the Northern Kentucky senator told her colleagues before the vote Thursday.
Low-risk pregnant women would benefit most from the legislation, Funke Frommeyer said. Without the bill, she said those women have little access to a “holistic” birth experience but instead must give birth at home often without support, or at a hospital.
“We see people doing one of the following: they may forego the care truly desired and plan a hospital birth which is covered by Medicaid, they may make sacrifices and find a way to pay out of pocket for (a certified professional midwife), they may have home birth without a trained provider or sometimes without anyone at all,” said the senator.
The bill would also save money, she said, by reducing Medicaid reimbursement that now goes to hospitals for facility fees and birth interventions like epidurals and induced labor — services not provided by certified professional midwives. For women and infants who do require additional medical care, a fiscal note attached to SB 89 estimates an annual cost to Medicaid of $392,756, with $117,772 paid by the state and the rest covered with federal funds.
About one-third of home births (or approximately 130 in Kentucky) would require transport to a hospital, with added cost for neonatal intensive care, according to the fiscal estimate.
Funke Frommeyer – who also has legislation pending to eliminate the certificate of need requirement for freestanding birth centers served by midwives – told the Senate that SB 89 reflects Kentucky’s “pioneer women.”
“We’re strong. We’re capable. And we want a wellness revolution,” she said. “We would like to make what’s old new again.”
Although SB 89 passed with bipartisan support, including two Democrat cosponsors of the bill, three Republican senators voted against it. They were Sen. Donald Douglas (R-Nicholasville), who is a physician, Sen. Chris McDaniel (R-Ryland Heights), and Sen. Phillip Wheeler (R-Pikeville).
None of the three commented on why they voted against the bill on the Senate floor.
Voting yes was Sen. John Schickel (R-Union). The NKY senator remembered late Sen. Tom Buford (R-Nicholasville) in his remarks. Buford – who died in 2021 after serving nearly 30 years in the Senate – was the sponsor of a 2019 bill (SB 84) that led to the licensing of certified professional midwives in Kentucky.
“When I first came to the General Assembly, this was (Buford’s) issue,” said Schickel. “He worked on it for many years and had a lot of resistance. I think it’s a lesson for all of us that these things don’t happen overnight. We are on other’s shoulders.”
Another maternal bill this session sponsored by Funke Frommeyer (with Schickel as lead cosponsor) would exempt freestanding birth centers — non-hospital facilities that offer midwife-assisted birth outside the home.
That bill is SB 103. Should it become law, the bill 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.”
SB 103 was assigned to the Senate Health Services Committee on Jan. 12. So far, it hasn’t reached the Senate floor.
Rebecca Hanchett is LINK nky’s Frankfort correspondent. You can reach her at rhanchett@linknky.com