Legislators Hear Bill to License Freestanding Birth Centers as Lower-cost, Midwifery-led Option

Senator Gulick, the Senate sponsor of S.18, told a legislative committee that the bill would create a legal pathway for freestanding birth centers in Vermont and that it has strong support in the Senate. “This bill that is near and dear to my heart,” she said, adding that it passed her committee unanimously and drew no questions on the floor.

The bill would establish licensure, inspection and rulemaking for freestanding birth centers through the Vermont Department of Health. Lauren Laymon, general counsel at the Department of Health, told the committee the department would oversee an application, inspection and licensing process and lead rulemaking on staffing, equipment, complaint processes and quality assurance. “We would collaborate with the Department of Disabilities, Aging and Independent Living,” Laymon said, and implement the licensing language as written.

Why it matters: proponents and some state health officials told the committee that freestanding birth centers are an evidence-based option for low-risk pregnant people and could expand choice while lowering per-delivery costs for payers. Senator Gulick cited national endorsements and federal guidance, saying the White House maternal health blueprint and major professional groups endorse birth centers as “a safe and evidence based option for low risk people.” Alice McCracken, Director of Communications and Legislative Affairs for the Department of Vermont Health Access (DVHA), confirmed Medicaid already covers home and hospital births and that “Vermont Medicaid covered nearly 2,000 deliveries or about 37 percent of all births in the state” in 2023, adding that a state plan amendment would be required to reimburse services in freestanding birth centers.

Proponents pointed to cost comparisons and published data. Senator Gulick cited a payer document saying a vaginal birth at a tertiary hospital could cost about $17,100 while a freestanding birth center delivery could cost about $2,870. She also cited Agency of Human Services vital statistics and local hospital delivery counts to argue that some births currently occur out of state or at home and could be captured by a birth center.

Administrative and payer issues raised at the hearing include the need for VDH rulemaking on facility standards and a federal state plan amendment (SPA) to get Centers for Medicare & Medicaid Services (CMS) approval for Medicaid reimbursement of birth-center services. DVHA asked the committee to remove or change a hard deadline in the bill for submitting a SPA so the agency would have “adequate time to pursue the requested state plan amendment.”

Supporters at the hearing included certified nurse midwives and the Vermont Birth Center Coalition, who described typical birth-center staffing, capacity and prenatal/postpartum services; Erin Mandeville, a certified nurse midwife, said many birth centers average four to eight births a month, with busier centers doing 15–20 a month. The Vermont Medical Society also testified in favor of patient choice and accredited birth centers while urging attention to sustaining hospital labor-and-delivery services that accept transfers when higher-risk care is needed. “We support accredited birth centers as safe places to birth and support patient choice,” Jessa Barnard, executive director of the Vermont Medical Society, said.

The committee did not take a formal vote during the transcripted hearing. Staff and agencies were asked to supply data and to work with VDH and DVHA on implementation details, including the timing and mechanics of a SPA and the rulemaking process for licensure.

Looking ahead: the key next steps raised in testimony were (1) VDH rule development for licensing standards and inspection practice, (2) DVHA and the Agency of Human Services coordinating a SPA request to CMS for Medicaid reimbursement, and (3) additional data requests on hospital catchment deliveries and financial modeling to quantify expected programmatic and fiscal impacts.