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Committee advances bill to license freestanding birth centers; insurance and Medicaid coverage discussed
Summary
S.18 to create a licensing regime for freestanding birth centers and require insurance coverage of midwifery services in those centers was reported favorably by the finance committee (7-0). Ongoing questions include rural hospital birth-unit impacts and Medicaid implementation timing.
The Vermont Senate Committee on Finance on March 18 voted 7-0 to report S.18, which establishes a licensing framework for freestanding birth centers and requires health insurance to cover midwifery services provided in those centers. Committee members heard from Department of Health staff and witnesses who said licensing will be handled by the Department of Health with inspection and survey support from partner agencies.
Under the committee amendment discussed, a licensed birth center is a facility whose primary purpose is to provide midwifery care, low-risk deliveries and newborn care immediately after delivery for generally less than 24 hours; the bill excludes hospitals and ambulatory surgical centers. The measure requires an application and sets an initial application/renewal fee of $250 to cover licensing costs. The bill also clarifies that existing statutes requiring insurance coverage for licensed midwives and certified nurse-midwives will include services provided in birth centers. The Medicaid coverage requirement for birth-center services would take effect on the earlier of when birth-center rules are adopted or Jan. 1, 2027; the bill directs the state to seek federal approval if a state plan amendment is required.
Witnesses, including a representative identified as Veil Livingston from a Vermont maternal health coalition, told the committee that freestanding birth centers would likely be small and that advocates expect only a few to open because of workforce constraints. Livingston said many Vermonters currently leave the state to seek birth-center care in neighboring states that already license such facilities, and argued that centers would likely attract those patients and some who now plan home births. Committee members asked about potential impacts on rural hospital birth-unit census; witnesses said there is no evidence from other states that licensed birth centers have caused hospital units to close, and advocates emphasized that centers are intended to work cooperatively with nearby hospitals where necessary.
Joint Fiscal Office staff said the bill has no immediate fiscal impact on the state budget and estimated that license revenues would be nominal and tied to the number of applicants. The committee voted to report S.18 favorably and prepared the bill for floor consideration.
