“Supervision” Language Used by Medicaid
A member of the audience commented on the inability of a certain home birth services organization staffed by certified nurse-midwives to provide Medicaid care to their clients because of the “supervisory” language used in the Medicaid application. Specifically, the application required that a supervisory physician be present. She asked whether there is any federal-standard application that replaces “supervision” language with “collaboration” language. Nolan responded that there is no federal standard for use of “supervisory” language. Use of that language varies state by state, with respect to both practice laws and state Medicaid programs, and the two are not necessarily aligned (e.g., even though a state’s licensure laws might not require supervision, its Medicaid program might).
Medicaid Reimbursement for Midwives
A member of the audience clarified that there is a federal mandate that all state Medicaid programs reimburse nurse-midwives, regardless of where those births occur (at home, in a birth center, or in a hospital). Cross-Barnet added that Medicaid is mandated to pay for licensed midwifery care, that is, any midwife who is licensed in her or his state, but that other factors, like malpractice insurance, may restrict the care that licensed midwives are actually able to provide. To further clarify, Medicaid only reimburses midwives for care in certain settings, so while they do have to provide licensed midwives with reimbursement, they do not necessarily have to pay for home birth, though some states do.