Under-utilization of high-value, evidence-based care, such as the midwifery-led model of care, and over-utilization of unnecessary care, such as cesarean deliveries without indication, are gaining attention in the U.S. as the nation attempts to address growing concerns about maternal health. These concerns include rising rates of maternal mortality and morbidity, increased costs of care, poor or even traumatic patient experiences, workforce shortages, and decreases in access to care in some regions of the country. The alarming trends of racial/ethnic, geographic, and socioeconomic disparities are necessitating local, state, and national conversations. These concerns are compounded by increased awareness of the role that unmet social needs, implicit bias, and structural racism have on maternal and infant outcomes. The factors contributing to poor maternal and infant health outcomes in the U.S. are extensive and complex. There will not be only one intervention that will address all of these factors. As the nation considers the combination of potential interventions, it is important to fully consider opportunities to implement a high-value, evidence-based maternal model of care such as the midwifery-led model, both in hospitals and free-standing birth centers. Midwifery-led care might be a means to improve health equity and ultimately, maternal and infant outcomes for pregnant individuals enrolled in Medicaid.

This report reflects the Institute for Medicaid Innovation’s ambitious national project to answer critical questions that are needed to advance maternal health, specific to the midwifery-led model of care, for the Medicaid population:

  1. What is the current evidence on the midwifery-led maternity model of care and freestanding birth centers? Are there differences between Medicaid and commercially insured populations?
  2. What are the state variations in access and coverage for the Medicaid population specific to midwifery services and freestanding birth centers? What are the policy barriers by state?
  3. What are the innovative initiatives and best practices specific to the Medicaid population for midwifery-led models of care and freestanding birth centers?
  4. What are the billing codes and quality measures for midwifery services and freestanding birth centers?
  5. What emerging payment and contracting approaches align Medicaid and managed care resources?
  6. What is the business case and return on investments (ROI) to support the financial models of the midwifery-led model of care?

Authors: Institute for Medicaid Innovation

Publication Date: 2020

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