Diane Graham, a longtime patient advocate, told the commission that licensed midwives face structural barriers to serving Medicaid beneficiaries and that those barriers are contributing to shrinking childbirth options in rural Virginia.

Graham said that under current policies many licensed midwives cannot bill Medicaid until late in pregnancy (sometimes as late as 36'38 weeks), making midwifery care financially unsustainable for small practices and undermining continuity of care. She also said some managed care organizations require malpractice insurance terms or premiums that are infeasible for small midwifery practices.

"The result is not that midwives are unwilling to serve Medicaid families; it's that the system structurally prevents them from doing so," Graham said. She called attention to a recent closure of a hospital-based midwifery practice in Farmville and said that licensed midwives are often the only nearby maternity providers in many rural communities.

Graham asked the commission to support a budget amendment to expand access to midwifery care under Cardinal Care (Virginia Medicaid), noting that continuity of care from the same midwife or small team is associated with better birth outcomes and lower preterm birth rates.

Why it matters: the commission has identified maternity care deserts and rural shortages of obstetric services as a state concern. Advocates argue timely Medicaid access and reasonable reimbursement are necessary to sustain community midwifery practices and preserve local birth options.

What the commission heard: the public comment asked for a budget amendment and said the submitter would follow up with cost details; commissioners said they would watch for the budget request and thanked the commenter.