July 9th, 2019
Policy Update: Exciting Federal Opportunities for CPMs on the Horizon

Historic 116th Congress
A vibrant new energy is palpable in the halls of this 116 th Congress, the most racially, ethnically and socially  diverse in history, and exciting new federal opportunities for CPMs are on the horizon.  A new commitment among our nation's leaders has emerged to address the unconscionable rates of mortality, preterm birth and severe complications of pregnancy suffered by birthing people in our country, and especially and disproportionally by Black and Native American childbearing people - along with a critical recognition that midwifery care is key to improving outcomes while lowering costs.  Two bills to support the education of midwives are on or will soon be on the docket this session, supporting the growth of and urgently needed racial diversity in the midwifery profession.
Two Bills:  First-Ever Federal Legislation to Fund the Education of CPMs

Funding for Midwifery Education included in the House 2020 Appropriations Bill
On June 19th, the U.S. House of Representatives passed H.R. 2740, the Departments of Labor, Health and Human Services, and Education Appropriations Act of 2020. NACPM and ACNM were invited to work with Congresswoman Roybal-Allard's office to include  $2,500,000  in this legislation to be allocated to educate midwives within the Scholarships for Disadvantaged Students program in Title VII of the Public Health Service Act. MEAC and ACME-accredited schools and programs will be able to apply for grants for direct support for CPM, CM and CNM students of color and Native American students. This funding will help address the critical national shortage of birth care providers, and specifically address the urgent lack of adequate racial representation in the birth care workforce . The Senate is currently at work on their version of the 2020 appropriations bill, after which the House and Senate bills will be reconciled to produce the final Congressional appropriations legislation for 2020. NACPM will continue to work with Congresswoman Roybal-Allard and Congress to advance this exciting and important legislation through these next steps and will keep you up to date.

Midwives for Maximizing Optimal Maternity Services (Midwives for MOMS) Act of 2019
NACPM has been privileged, along with ACNM, to assist in the development of legislation with Congresswoman Roybal-Allard's (D-CA-40) office that has the potential to revolutionize progress for the Certified Professional Midwife profession and access to care for childbearing people in our country.
 
This legislation will authorize the first-ever federal funding program that will support the education of CPMs. Soon to be introduced, the bill will authorize a funding stream of $15,000,000 for fiscal years 2021-2025 in Title VII of the Public Health Service Act. This funding will apply to CPM and Certified Midwife (CM) schools that are accredited by MEAC or ACME. (The Act authorizes a corresponding $20,000,000 for nurse-midwifery education in Title VIII.) Grants from this funding can be used for these purposes:
  • Establish or expand CPM and CM accredited midwifery schools  and programs
  • Secure, prepare and/or provide support to increase the number of qualified preceptors for training the students of an accredited CPM or CM midwifery school or program
  • Provide direct support for CPM and CM students (stipends/tuition reimbursement), including minority students, in an accredited midwifery school or program
Special consideration will be given to schools that prioritize students planning to practice in health professional shortage areas and that demonstrate a focus on increasing racial and ethnic minority representation in midwifery education.

Once the Midwives for MOMS Act is introduced, NACPM will reach out for your help securing your legislators' support for this exciting and important legislation. We at NACPM are thrilled with this opportunity and its potential to transform our profession.

Key Federal Policy Opportunity for CPMs:
Including CPMs in the Federal Medicaid Program

NACPM commends Congresswoman Gwen Moore (D-WI-4th) for her focus on including CPMs in the federal Medicaid program in H.R. 2751- the MAMA's First Act, and the Midwives Alliance of North America (MANA) for their support to this office on this legislation.
 
Securing federal recognition and inclusion in the federal Medicaid program for Certified Professional Midwives by amending the Social Security Act has been a top priority for NACPM since 2009. CPMs have a critical role to play in improving outcomes for all childbearing people in the U.S., and in eliminating racial inequities and disparities for Black and Native American and Alaska Native people and their infants in our country. Including CPMs in the federal Medicaid program is urgently needed to achieve these goals. NACPM appreciates Congress's continued and current interest in this policy, one that will make such a difference in outcomes for those most affected, while also reducing healthcare costs.
 
Historical Context for this Policy
Congresswoman Moore has been a champion of this initiative since its inception, and was an original co-sponsor of the Access to Certified Professional Midwives Act introduced in the 112th and 113th Congresses by NACPM - H.R. 1054  and H.R. 1977 . NACPM subsequently consulted with her office during the 114th Congress on draft legislation, the Midwifery Access Act of 2015, to federally recognize both CPMs and Certified Midwives (CM). Following six years of significant investment and dogged advocacy with Congress, this draft bill reflected a new strategy to overcome several years of persistent opposition and to achieve success for this policy by including US MERA agreements for accredited education and the Midwifery Bridge Certificate for purposes of reimbursing CPMs in the federal Medicaid program.
 
Since 2016 when the current administration came into office, NACPM has focused our efforts on working behind the scenes to listen to concerns from midwives about the implications for and impact on their states of this federal policy, to search for innovative solutions, to build resources and to cultivate key relationships. Now, with the advent of this new Congress and its welcome commitment to using the power of the federal government to improve the health and save the lives of childbearing people in our country, there are new opportunities for success. NACPM has renewed its commitment to working with Congress and with colleagues to shape this important policy of including CPMs and CMs in federal Medicaid in a way that can be as inclusive as possible and in a way that has the best chance of becoming law.
 
As of April 2019, of the thirty-three states that license CPMs , only fourteen of these states include CPMs as reimbursed providers in their state Medicaid plans. In addition to expanding access to CPM care to all states where CPMs are licensed, recognizing CPMs in the Social Security Act (the law that houses the Medicaid and Medicare statutes) would:

  • Open doors for CPM inclusion in the systems of care and reimbursement that define the delivery of health care in our country
  • Support participation in other federal insurance programs, such as Tricare, expanding access to care for members of the military
  • Allow CPM participation in federal student loan repayment programs and support the increase of critical racial representation in the CPM workforce
  • Open access to participation in the National Health Service Corps - student loan forgiveness for serving underserved areas & populations
  • Allow CPM direct participation in Federally Qualified Health Centers - a sustainable model for serving Medicaid populations
 
In 2017, NACPM wrote and distributed a set of Briefing Papers: Midwifery Landscape and Future Directions  that describes the momentum generated by the US MERA agreements in gaining legal recognition and access to midwifery care for more people. The papers address the opportunities to overcoming long-standing barriers, both state and federal, that have stood in the way of midwives and birthing people for far too long. The NACPM Briefing Papers are designed to answer questions and engage midwives and students in further conversations about the future of the profession. One of the briefing papers Certification and a National Credential  has recently been translated into Spanish. We are working to ensure that the remaining papers will also be translated.

We invite you to explore and engage with us:

NACPM's position on the Portfolio Evaluation Process (PEP)

NACPM has been asked by members of our community to clarify our position in relationship to the Portfolio Evaluation Process (PEP). 

Importantly, NACPM values the  Portfolio Evaluation Process (PEP) as an innovation ahead of its time, whose attributes of accessibility, affordability, and student-directed learning and pace are only now being acknowledged and reflected in the most cutting- edge innovations in higher education in the country - in particular in competency- based, direct-assessment education . NACPM is committed to advancing midwifery education that reflects the innovations, affordability, accessibility and benefits to students that are embodied in the PEP process within accredited institutions and programs.

You can read   NACPM's full statement here. 


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