Preserve the Freedom to Make Birthing Choices

If you are a well and healthy childbearing woman (as are most pregnant women in the U.S.), you can consider giving birth in a hospital, an out-of-hospital birth center, or in your home. Or can you? If your pregnancy care and birth is covered by Medicaid, your options may be limited to hospital birth only.

Birth centers have been recognized by Centers for Medicare & Medicaid Services as a Medicaid provider type in State Medicaid Plans since 1987. Recently, however, CMS has disallowed such payment by several state Medicaid Agencies, including Alaska, South Carolina, Texas, and Washington State, claiming that it lacks clear statutory authority and direction to allow these payments.

After reimbursing birth centers for decades, Medicaid programs have begun to withhold payment because the relevant federal statute does not authorize coverage. A Texas judge recently ruled that from September 1 onward the Centers for Medicare and Medicaid Services (CMS) does not have to pay its federal share of Medicaid fees to the state's 43 birth centers, a ruling that CMS could apply to the entire country.

Birth center care is safe, effective, and satisfying for women and families, and a great value for payers. For most women it is an ideal form of care. This ruling unfairly jeopardizes access of all Medicaid beneficiaries to excellent birth center care. Moreover, birth center care is disappearing for all childbearing women because many birth centers depend on Medicaid payments to continue to keep the doors open.

Please take a minute now to encourage members of Congress to give CMS the authority to pay for birth center care — an essential option for women and babies and a great value to taxpayers.

Links below provide facts and figures about out-of-hospital birth center care and its advantages in comparison with typical hospital care both for birthing women and newborns and for those who pay for their care.

Choosing a Place of Birth
Chart: Birth Charges of Birth Centers versus Hospitals
Evidenced-Based Maternity Care Milbank Report