In a significant policy shift, Illinois has implemented equal Medicaid reimbursement rates for certified nurse-midwives (CNMs) and physicians, aiming to enhance access to perinatal care and improve pregnancy outcomes statewide.
Policy Implementation and Background
Prior to January 1, 2006, Medicaid programs in 20 states, including Illinois, paid CNMs 10% to 25% less than their physician counterparts. Recognizing the benefits of CNM-led prenatal and intrapartum care—which include better perinatal health outcomes and reduced costs for low-risk pregnancies—the Illinois legislature mandated that Medicaid reimburse CNMs at the same rate as physicians. This policy change sought to address disparities in perinatal care and support the growing need for qualified midwifery professionals.
Study Results Highlight Impact
A comprehensive study examining all live births in Illinois from June 2003 to November 2009 revealed that after the policy’s implementation, there was an increase of 48.1 per 10,000 live births attended by CNMs compared to a synthetic control group. Additionally, the trend showed a rise of 2.8 CNM-attended births per 10,000 live births annually. Although the confidence intervals suggest variability, the overall data indicate a positive association between equal reimbursement rates and the utilization of CNMs in childbirth.
- Equal reimbursement rates incentivize more CNMs to participate in Medicaid programs.
- Increased CNM participation can lead to improved access to personalized perinatal care.
- Potential long-term cost savings for Medicaid due to lower complication rates in CNM-managed births.
Implementing equal reimbursement rates for CNMs not only supports the workforce of midwives but also enhances the quality of maternal and neonatal care available to Medicaid beneficiaries. This policy serves as a model for other states grappling with similar disparities in perinatal care provision.

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