Box 1—

System Changes to Scale the Strong Start Birth Center Model of Care

Scaling birth centers to meet the needs of mothers and babies in the United States will require the following changes:

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Increase Medicaid reimbursement for birth centers and midwives.
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Require managed care organizations to contract with birth centers and midwives.
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Include and highlight birth centers and midwives as categories in provider directories.
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Optimize state birth center regulations recognizing Commission for the Accreditation of Birth Centers accreditation for licensure.
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Remove certificate of need requirements.
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Remove requirements for medical directors.
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Remove signed transfer agreements with hospitals.
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Pilot birth centers in the poorest performing Strong Start maternity care homes sites.
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Incorporate birth centers into federally qualified health centers, rural health clinics, and critical access hospitals.
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Fund midwifery education in a manner similar to medical education.
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Remove restrictive state licensure of midwives so they can practice to full potential.
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Increase the number and capacity of midwifery education programs.
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Establish a midwifery education program within consortium of historically Black colleges and universities.
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Pass Black Maternal Health Momnibus Act of 2021 (HR 959 and S 346), which has provisions for many of the above recommendations.
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Pass the reintroduced Birth Access Benefiting Improved Essentials Facility Services Act (HR 3337 and S 1716) to require the Secretary of Health and Human Services to establish a Medicaid demonstration program to develop and advance innovative payment models for freestanding birth center services for women with low-risk pregnancies and for other purposes.