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Non-Hospital Births Increasing, But Insurance Coverage Sometimes Elusive

Non-Hospital Births Increasing, But Insurance Coverage Sometimes Elusive

March 4, 2014 — Private health coverage is uncertain for births attended by midwives or at freestanding birth centers, despite an increasing number of women who prefer those options, Kaiser Health News reports (Andrews, Kaiser Health News, 3/4).

CDC: Non-Hospital Births Increasing

CDC on Tuesday released a report that found about 1.36% of births in 2012 occurred outside of hospitals. According to CDC, the non-hospital births included roughly 35,000 home births and about 16,000 births at freestanding birth centers (Stobbe, AP/Sacramento Bee, 3/3).

Although deliveries at birth centers remain a tiny fraction of all births, the number increased by about 70% between 2004 and 2012, according to the report (Kaiser Health News, 3/4).

White women and women who live in remote areas are the main groups driving the increase in non-hospital births, experts said. About one in 49 white women delivered outside of hospitals, compared with one in every 200 Asian, black and Hispanic women, the report found (AP/Sacramento Bee, 3/3).

Appeal of Birth Centers

Births centers typically are staffed by midwives and eschew fetal monitoring, drugs and other interventions for low-risk births.

Births at such centers also tend to be less costly than hospital births. In 2010, the average hospital charge for a vaginal birth without complications was $10,166, compared with $2,277 for a vaginal birth at a birth center, according to research from the Agency for Healthcare Research and Quality and the American Association of Birth Centers.

Coverage Gaps

Under the Affordable Care Act (PL 111-148), Medicaid -- which covers about 50% of U.S. births -- is required to cover the services of licensed, freestanding birth centers. Medicaid coverage of midwifery services previously was mandated under federal law.

Coverage of birth centers and midwives is less secure in private plans. Per the ACA, health plans must cover maternity and newborn care as one of 10 essential health benefits, and they cannot discriminate against licensed or certified medical providers who would like to participate in their networks.

However, the ACA does not require insurers to contract with any particular provider, according to Dania Palanker, senior counsel at the National Women's Law Center.

Although some experts predict more private health plans will cover birth centers now that Medicaid does, advocates are concerned about how the nondiscrimination provisions will be applied and enforced. The Department of Labor has said it does not plan to issue further guidance.

Jesse Bushman, director of advocacy and government affairs at the American College of Nurse-Midwives, said the uncertainty leaves midwives "in the dark" (Kaiser Health News, 3/4).