Equitable Medicaid Reimbursement Policies Increase Midwifery-Led Births: An Interrupted Time Series Analysis With a Synthetic Control Group

Abstract

Introduction

Birthing people in the United States suffer from poor pregnancy outcomes and a lack of perinatal care providers, especially nurse-midwives. Prenatal and intrapartum care by a certified nurse-midwife (CNM) is associated with improved perinatal health and lower costs among low-risk pregnant people. Medicaid programs in 20 states reimburse CNMs 10% to 25% less than physicians. On January 1, 2006, an Illinois policy went into effect requiring Medicaid to reimburse CNMs at the same rate as physicians. The objective of this study was to evaluate the association between equal Medicaid reimbursement of CNMs and physicians and CNM-led births in Illinois.

Methods

We included all live births to people aged 18 years or older in Illinois between June 1, 2003, and November 30, 2009. We used an interrupted time series analysis, with and without a synthetic control group, to assess the change in the level and trend of the proportion of CNM-attended births after the implementation of the Illinois policy.

Results

The study period included 1,103,238 eligible live births in Illinois. Illinois and the synthetic control group were similar overall. Compared with a synthetic control group, we found an increase of 48.1 per 10,000 live births in the level of the number of births attended by a CNM (95% CI, −175.7 to 272.0) and an increasing trend of births attended by a CNM (2.8 per 10,000 live births; 95% CI, −7.4 to 13.1).

Discussion

These findings support evidence that equitable reimbursement will help increase access to CNMs among the Medicaid population.