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Mass. midwifery licensure offers lessons and questions for Connecticut, speaker says
Summary
Rebecca Herman of the Bay State Birth Coalition described Massachusetts’ new certified professional midwife (CPM) licensure law, highlighting statutory protections, implementation choices and remaining questions about Medicaid payment, regulation and client autonomy.
Rebecca Herman, a certified professional midwife and board member of the Bay State Birth Coalition, told the Connecticut Midwestern Working Group on March 28 that Massachusetts’ new law licensing CPMs prioritized self‑regulation, flexible regulatory authority and inclusion of licensure within a broader maternal‑health equity package.
Herman said the statute requires a board of registration with a CPM majority, allows CPMs to own and run birth centers, mandates that the state public payer (MassHealth) allow CPMs to enroll, and intentionally left detailed scope, prescriptive formularies and many clinical specifics to rules and guidance to preserve flexibility as evidence and practice evolve.
Those choices, she said, were deliberate responses to concerns that folding midwifery into other professions would dilute the model of care. “When midwifery gets folded into other professions, it gets diluted and it becomes more like nursing. It becomes more like medicine. And we really need midwives to self‑regulate if we’re gonna keep this unique model of care,” Herman said.
Herman framed licensure as one element in a package of maternal health measures that included mandates for donor human milk coverage and expanded perinatal mental‑health screening. She said embedding licensure in a broader equity bill helped build a wider advocacy coalition and shifted legislative conversations toward access and choice rather than treating community birth as a niche issue.
On implementation, Herman identified three areas Connecticut advocates should watch: Medicaid payment rates and enrollment rules, detailed regulatory language on scope and risk, and protections for client informed consent and autonomy. She said Massachusetts has not yet set MassHealth payment rates for CPM services and warned that insufficient payment would limit access even when licensure exists.
“If Medicaid doesn’t pay an appropriate amount for the service…there’s no way a home birth midwife could take clients for something like that,” Herman said, noting wide state‑to‑state variation in Medicaid payments for out‑of‑hospital births.
Herman described the coalition that supported passage as broad, including reproductive‑justice and racial‑equity groups, ACOG’s state chapter (which later endorsed the bill), the American College of Nurse‑Midwives and some hospital partners. She named the Mass Medical Society as the law’s principal organized opponent and said last‑minute lobbying efforts sought restrictive “low‑risk” language that advocates pushed back on through rapid mobilization.
Speakers raised concern that regulation could reduce client autonomy and cited examples in other states where families faced Child Protective Services referrals after receiving care from unlicensed providers. Dalian, who said she represents Hartford HealthCare, asked specifically whether midwifery care increased CPS/DCF referrals. Herman said pediatricians or receiving hospitals sometimes file reports alleging medical neglect when families used unlicensed providers; most such investigations end without removal but can cause traumatic, prolonged scrutiny for families.
Herman also described three credentialing pathways Massachusetts included for initial licensure eligibility and said the inaugural regulatory board’s composition unintentionally included a requirement that initial appointees be graduates of a particular education pathway (MEAC‑accredited programs). She said subsequent boards will not retain that restriction, but the drafting hiccup illustrates the practical challenges of last‑minute legislative editing.
Herman urged Connecticut listeners to assess local agency champions and staffing (for example, presence of supportive Department of Public Health and Medicaid staff), to build broad coalitions, and to prepare for contentious regulatory drafting even after a statute passes. “This would never have happened without a coalition. Full stop,” she said.
Votes at a glance The group approved meeting minutes from Nov. 22 by voice vote during the March 28 session (motion to approve by Priya; second by Amy).
