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N.J. hearing spotlights barriers to out-of-hospital births; witnesses urge pay parity, Medicaid coverage and fewer practice restrictions
Summary
Midwives, doulas, hospitals and insurers told a New Jersey Assembly panel that expanding births outside hospitals will require payment parity, clearer Medicaid rules for birth centers and removing mandatory physician collaborative agreements that limit midwives’ independent practice.
Members of an Assembly Aging and Human Services Committee heard two hours of testimony on expanding out-of-hospital births in New Jersey, where witnesses said regulatory and insurance rules make community births hard to access for many families.
Several witnesses urged policy changes to increase the midwifery workforce and make birth centers and home births affordable. Arminie Pierre Jacques, a program officer at the New Jersey Health Care Quality Institute, recommended five steps including “establishing pay parity for midwives,” expanding insurance and Medicaid coverage for midwifery services, improving licensing and approval processes for birth centers, implementing a statewide transfer agreement with hospitals, and eliminating mandatory collaborative agreements with physicians that restrict midwives’ autonomy.
The testimony cited data and lived experience. Julie Blumenfeld, a certified nurse midwife and Rutgers faculty member, told the committee that “midwifery is its own profession” and that midwives in New Jersey attend only about 10% of births, far lower than in some other states. Ward Sanders, representing the state’s health plans, said insurers often lack clear contractual language about home births and birthing-center coverage, which contributes to inconsistent access. Sheila Reinardson of the Robert Wood Johnson Foundation argued that unequal reimbursement and limited birth-center availability worsen racial disparities in maternal outcomes.
Birth-center operators and hospital-based midwifery programs described how their models work in practice. Pam Harmon, director of women’s and children’s services at Saint Peter’s University Hospital and administrative director of the Mary B. O’Shea Birth Center, said hospital-owned freestanding birth centers operate with separate staff and accreditation, keep emergency equipment available, and maintain protocols to transfer patients when escalation of care is needed. Michelle Gabriel Caldwell, doula director of the Birth Center of New Jersey, said her facility’s 2023 patients were 50% Black and 25% Hispanic and urged state funding to address facility fees and geographic gaps.
Speakers repeatedly called for clearer Medicaid rules on birth-center facility fees and for pay parity that would apply to Medicaid managed care plans as well as fee-for-service Medicaid. Testimony noted a recent change that raised midwifery rates to 100% of the physician rate for Medicaid fee-for-service but said the increase did not apply to Medicaid managed care organizations, which cover a large share of Medicaid births.
Committee members asked detailed questions about safety protocols, triage and transfers, whether birth centers provide overnight stays (most do not), and how state law and certificate-of-need rules may affect new birth-center development. Witnesses pointed the panel to existing resources—including a planned community birth transfer resource kit from the ACOG Alliance for Innovation on Maternal Health—and to research on outcomes for planned home and birth-center births.
The committee chair closed the hearing saying the testimony generated many legislative ideas, and asked witnesses to provide follow-up material and contact information. The panel signaled it would pursue a package of bills on midwifery scope, reimbursement and birth-center licensing.
The hearing did not adopt new regulations during the session; it served to gather evidence and stakeholder recommendations for upcoming legislation.
