Minnesota lawmakers approved legislation requiring Medicaid to pay for home births, including paying nurses and midwives the same rate as doctors.
The bill, sponsored by a state senator who gave a political speech in 2022 while in labor, was passed as part of a special session agreement with Gov. Tim Walz in June. The legislation requires payment for Medicaid home births under certain conditions. Mothers must be “low-risk” patients and have a home birth and transfer plan to the hospital, if needed. Coverage would include prenatal, labor, birth, and postpartum care.
“SF 1113 aims to codify Medical Assistance coverage of birth services provided at home,” wrote Minnesota state Sen. Erin Maye Quade on Facebook. “In rural communities with limited or inconsistent access to perinatal care, home birth providers offer critical care to fill the gaps. This bill will allow home birth providers to serve more Medicaid clients who choose to give birth in their homes and improve reimbursement rates for those providing these services.”
Physician Rates for Nonphysicians
Minnesota’s expansion of Medicaid to include home births is part of a growing trend since COVID-19. A report by KFF in 2022 found 25 out of 42 state programs provided some level of home birth coverage, but many require a physician’s presence.
Minnesota’s new law will pay professional providers such as midwives, doulas, and nurses 100 percent of the physician rate and does not require a medical doctor to be present.
“It seems that Minnesota is devaluing the services of the most highly trained practitioners in caring for a high-risk population,” said Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons. “A group that has a higher mortality rate is more likely to need services not available at home, such as transfusions or surgical interventions for hemorrhage.”
The state’s Medicaid program will also pay mothers a “facility services fee” at 70 percent of the statewide average hospital rate for an uncomplicated non-caesarean delivery at home.
“If a patient is transported to the hospital before delivery, the facility service payment will be reduced to 15% of the average hospital rate,” a summary of the bill states.
Equity over Safety
Although the bill is intended to provide more equitable treatment to low-income people, it could endanger the health of mothers and newborns, says Matt Dean, a policy fellow at the Center of the American Experiment.
“A 2022 Minnesota study found that black women were 2.3 times more likely to die from a childbirth-related event than white women,” Dean wrote. “Given that 72.9 percent of all pregnant black women in Minnesota are served by Medicaid, this population is at a significantly higher risk for complication and possible death during childbirth. Keeping them out of the hospital will make that worse, not better.”
Classifying home births as no different from hospital deliveries sends a false message, says Dean.
“Significantly, pregnant women of color are being told that hospitals are inherently unsafe,” wrote Dean. “The number of black women who delivered at home tripled in the years 2016 through 2023. While there are challenges to care for marginalized populations, scaring them away from hospitals is just plain dangerous.”
Flight from Safety
The characterization of hospitals as unsafe puts mothers and children in greater danger of poor treatment outcomes, Dean told Health Care News.
“The trope of the ‘racist hospital’ is driving moms toward care that is unquestionably less safe for them and their babies,” said Dean.
“Paying Medicaid patients to give birth at home will hurt African-American women and their babies because once again our woke ‘betters’ got it backward,” said Dean. “The infant and maternal mortality rates will go up, not down, if women are paid to stay away from the hospitals for a patient population with less access to prenatal care and higher likelihood of needing lifesaving interventions unavailable at home”
Ideology Against Quality
Legislators should emphasize quality of care, not ideology, says Donna Jackson, a senior policy analyst with the Committee for a Constructive Tomorrow (CFACT) and a black mother of five children.
“Equity always seems to come with lowering the quality of care and services for minority communities while pretending to show compassion,” said Jackson.
“Having access to high-quality health-care services is absolutely critical for minority birth mothers, who tend to suffer from several high-risk health conditions such as high blood pressure, diabetes, and so on that put their pregnancies at risk,” said Jackson. “This move to push pregnant minority mothers toward home deliveries shows the real focus is on ideology instead of access to high-quality health care.”
Status over Substance
Although home birth has grown in popularity over the years and has become more sophisticated, it is still a niche market, says Dean.
“Now, with pricey doulas and midwife services available to wealthier patients, advocates are demanding Medicaid moms have access to home delivery,” wrote Dean. “While some studies show planned home births have comparable outcomes when conditions are perfect and predictable, the factors that make things perfect are far less predictable for the poor as compared to the rich. Many advocates are the highly educated, wealthy folks who, for their own care, demand and receive concierge-level services often paid for in cash.”
Bonner Russell Cohen, Ph.D., ([email protected]) is a senior fellow at the National Center for Public Policy Research.
Bonner R. Cohen is a senior fellow with the National Center for Public Policy Research, a position he has held since 2002.
