Comparison of Medicaid financing for birth centers: a nine-state policy analysis

Background: The United States continues to face poor maternal health outcomes, and freestanding birth centers are a safe alternative to hospitals, offering midwifery care for low-risk birthing people. Not all birth centers accept Medicaid patients, however, and among those that do, low Medicaid facility reimbursement rates are a barrier to birth center operations and sustainability. This limits access especially for low-risk birthing people of color who may perceive traditional hospital care to be unsafe or culturally unsupportive. Methods: This cross-sectional policy analysis explored variation in U.S. Medicaid reimbursement rates for birth center facility fees. State similarity methods were used to match comparable states to New Jersey due to the state's evolving policy environment, resulting in a nine-state sample for the policy analysis. Results: Of this sample, six had published Medicaid rates for the birth center facility fee, with wide variation among the states, New Jersey's being the lowest and Massachusetts the highest, at four-and-a-half times New Jersey's rate. Significant variation in reimbursement rates was also identified when transfer to a hospital occurs. Conclusions: The findings suggest the importance of Medicaid reimbursement rates for birth centers as a policy pathway to improving access to this under-utilized care setting.