Equitable Medicaid Reimbursement Policies Increase Midwifery-Led Births: An Interrupted Time Series Analysis With a Synthetic Control Group.
Elizabeth Simmons, Kavita Singh, Mollie Wood and 4 others
PMID 40457897WHAT IT FOUND
When Illinois required Medicaid to pay certified nurse-midwives the same rate as physicians, the number of births attended by midwives gradually increased.
This suggests that equal reimbursement policies can improve access to midwifery care for low-risk pregnancies.
Key findings
01The proportion of CNM-attended births in Illinois increased from 4.8% before the policy to 5.8% after the policy.
02Compared with a synthetic control group, the trend in the proportion of CNM-attended births in Illinois increased by 2.8 per 10,000 live births after the policy.
03The study could not distinguish between Medicaid and non-Medicaid births because payer information was missing from the birth certificates used.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study could not separate Medicaid births from private insurance or self-pay births because the birth certificates used did not record the payer. This means the results likely underestimate the true effect on the Medicaid population specifically. The outcome was based on birth attendants recorded on the birth certificate, which is known to undercount CNM-attended births. It also missed prenatal care provided by CNMs if the patient transferred to a physician before birth. The synthetic control group was not perfectly matched to Illinois, having a higher percentage of non-Hispanic White births and previous cesarean births, which could influence the comparison. The study only looked at one state and one policy change, so it is unclear if the same results would occur elsewhere or for other types of providers.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that the policy caused an immediate surge in midwife-attended births. The study found no significant change in the level of births right after the policy, only a gradual increase in the trend over time. Additionally, because the data included all births regardless of insurance type, the specific impact on Medicaid enrollees cannot be isolated.