ACNM Survey Examines Coverage of Midwifery Care Through Marketplace Plans

A new survey by the American College of Nurse-Midwives (ACNM) of health insurers offering coverage through the health insurance marketplaces created under the Affordable Care Act (ACA) found that many plans are not fully utilizing the high value care offered by certified nurse-midwives (CNMs) and certified midwives (CMs).

According to a release, the results also indicate that policymakers need to do more to ensure plans take advantage of the services and outcomes associated with midwifery care.

Summaries of benefits describing plans available through the marketplaces do not describe the extent to which midwifery services are covered by marketplace plans. Using a methodology developed by the National Nursing Centers Consortium (NNCC), ACNM conducted its own survey between March and July 2014 to address this lack of clarity.

Collectively, CNMs and CMs attend approximately 8 percent of all US births, though the number varies widely by state. In several states, CNMs and CMs attend 10 to 20 percent of births. In New Mexico, CNMs attend more than 27 percent. CNMs are legally recognized in all 50 states and the District of Columbia. CMs are legally recognized in 5 states.

ACNM was able to survey 85 of the 277 marketplace insurers or 30.7 percent, located in 33 different states. While not every plan was able to respond to every question, ACNM found that 20 percent of responding plans do not contract with CNMs and 60 percent do not contract with CMs. Forty-seven percent of plans do not contract with birth centers, facilities for birth that are largely run by midwives.

"Certified nurse-midwives and certified midwives are proven providers of high value care. While most insurers have recognized this fact, it is a concern that a significant number have not yet taken advantage of the savings available under the midwifery model, which emphasizes physiologic birth and individualized, evidence- based care," said ACNM President Ginger Breedlove, CNM, PhD, APRN, FACNM. "This is a loss to both the plans and their enrollees. As major providers of maternity and newborn care, a required benefit category for marketplace plans, midwives should be included in all plans' provider networks."

The scope of practice for CNMs and CMs, defined by ACNM and incorporated into many state laws and regulations, includes primary care, gynecologic, and family planning services. The survey found, however, that 17 percent of plans do not cover primary care services provided by CNMs and that 14 percent restrict what CNMs can do beyond what is permitted under state laws or regulations.

"Inadequate inclusion of CNMs/CMs in provider networks limits choices available to women and reduces the value of the plans available to them," Breedlove said. "At a time when the nation is facing a significant shortfall of primary care providers and where many areas of our country have limited or no access to maternity care providers, this is a shortsighted approach. We encourage insurers to re-examine their practices and work with midwives to improve the value of the products they offer."

The American College of Nurse-Midwives is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States.

More information:

www.midwife.org

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