Hi, Cardinal readers. Welcome to the second edition of The Pulse, a weekly roundup of health-focused news. Each Thursday, we’ll bring you updates on health policy, community surveys, new clinical studies, programs and services in Southwest and Southside Virginia.
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Lawmakers are considering several bills at the General Assembly this year to address widening maternal health gaps in Virginia.
Access to care continues to diminish, particularly in rural communities, as hospitals shutter obstetrics units due to staffing shortages, financial strain and declining birth volumes. Each closure forces pregnant patients to travel farther for prenatal visits and delivery.
Most recently, Centra Southside Community Hospital closed its labor and delivery unit, leaving women in the region to drive at least an hour to give birth. The shutdown adds to a growing list of hospitals that have eliminated obstetrics services in recent years, contributing to what advocates describe as expanding maternity care deserts across the state.
Lawmakers have introduced proposals running from expanding Medicaid reimbursement and coverage for midwives and remote patient monitoring.
Expanding access to midwives
A budget amendment from Sen. Creigh Deeds, D-Charlottesville, and Del. Rodney Willett, D-Henrico County, would create a workgroup to address barriers that prevent Virginia mothers from accessing midwives through Medicaid managed care plans.
As obstetric units have closed across the state, midwives have stepped up to help fill in gaps. Virginia has more than 500 licensed midwives, but many of them do not accept Medicaid — even though Medicaid covers midwifery services — according to the Virginia Interfaith Center for Public Policy.
Many private midwifery practices struggle to contract with managed-care organizations, which administer the state’s Medicaid plans. The challenge is particularly steep for practices that offer home or community births and for certified professional midwives, who are not required to hold nursing degrees.
Certified nurse midwives, graduate-level registered nurses with specialized training in midwifery services, are covered under Virginia’s managed care organizations. Nurse midwives, however, are more likely to practice in hospitals, according to the Commonwealth Fund.
Certified professional midwives receive credentials through the Midwifery Education Accreditation Council. While certification does not require an academic degree, practitioners must complete an accredited training program, according to the American College of Nurse Midwives.
These midwives provide education, counseling and support to women and families throughout pregnancy, birth and the postpartum period. They conduct physical exams, administer medications and use medical devices as allowed by state law. They also order and interpret lab and diagnostic tests and recognize complications that require consultation or referral. Most attend home births or practice in birth centers.
Although Virginia Medicaid covers midwifery services, it only reimburses them through the fee-for-service model. To use that model, patients must call the managed care organization, opt out of managed care and enroll in fee-for-service Medicaid. This process can take months and requires significant health system literacy, according to Kathryn Haines, health equity manager with the Virginia Interfaith Center for Public Policy.
Under the fee-for-service model, the state pays providers directly for the covered service received by a Medicaid beneficiary. States generally set provider payments under this model.
Haines said the current reimbursement structure makes it difficult for small midwifery practices to stay financially sustainable.
The proposed workgroup would bring together midwives, representatives from the managed care organizations, birthing advocates, mothers and state officials, Willett said.
“[Midwifery] has been around forever, but in terms of doing what they’re doing now in more traditional settings, that’s new for a lot of people,” Willett said. “And so I think part of this is just getting people, MCOs, to understand and be comfortable with what they’re doing in the service and providing.”
The workgroup must present solutions to address those barriers, along with budget requests to the General Assembly by Dec. 15.
Maternal Health Monitoring Pilot Program
Sen. Jennifer Carroll Foy, D-Petersburg, is carrying SB 271, which would pilot remote monitoring for pregnant women with high blood pressure and gestational diabetes. Both conditions can be life-threatening and require frequent testing.
The bill directs the Department of Medical Assistance Services to select a participating managed-care organization to contract with a technology vendor. The vendor would provide remote patient monitoring tools so eligible participants can track vital signs from home.
High-risk pregnancies often require frequent appointments — sometimes twice a week in late pregnancy. At the same time, fewer obstetrics services are available throughout the state, forcing some patients to travel long distances for care.
Carroll Foy noted that nearly 31% of Virginia counties are maternity health care deserts, meaning there is no hospital or birth center offering obstetric care in the county. Between 2015 and 2022, preexisting hypertension rose 80%, and preexisting diabetes rose 50% among pregnant women, Carroll Foy said.
“We know that remote pregnancy monitoring has been linked to long-term success,” Carroll Foy said during a Monday Senate subcommittee meeting. “It’s a way for moms to be connected with devices like glucose meters, blood pressure cuffs and scales to monitor their vitals.”
The pilot would enroll up to 500 eligible participants in as many localities as needed. Participants would receive devices such as blood pressure cuffs and glucose monitors. If readings signal concern, a remote care team could intervene, adjust care plans or contact emergency services or the nearest OB-GYN.
The program would be implemented in 2027 and 2028. The Department of Medical Assistance Services would analyze claims data, vital statistics and electronic health records to determine impacts on maternal, fetal and neonatal health outcomes. The department would then recommend whether to expand the program.
Virginia has five Medicaid managed-care organizations. If all five participate, the pilot would cost $2.5 million, including $1.25 million from the general fund, according to the fiscal analysis. This is a one-time administrative fee, needing appropriation in fiscal year 2027.
The Senate Education and Health Committee referred the bill to the Senate Finance and Appropriations Committee on Feb. 5.
Insurance coverage for doula care services killed in subcommittee
A House subcommittee killed HB 1468 on Tuesday. The bill, carried by Del. Destiny LeVere Bolling, D-Henrico County, would have required private health insurers that already cover obstetrical services to also cover eight doula visits and labor support.
Virginia Medicaid began covering doula services in 2022 as part of an effort to reduce maternal and infant mortality and address health disparities. Medicaid currently covers eight doula visits spanning prenatal through postpartum care, along with labor support.
Research published in the National Library of Medicine links doula support to improved birth outcomes, lower cesarean rates and reduced use of pain medication.
Doulas also help mothers advocate for themselves and ensure that their concerns and birth preferences are acknowledged. Advocates say this role is particularly important for Black women and other women of color, who experience significantly higher maternal mortality rates.
The Department of Planning and Budget’s fiscal impact statement estimated that the state would need to appropriate additional general funds to the state employee health insurance fund. That fund pays claims for state workers.
Doula services typically cost between $800 and $2,500 per birth, according to the fiscal analysis. State human resources data show that 6% to 9% of U.S. births involve a doula, though utilization varies by region and access. The state estimated the proposal would cost the state employee health plan about $250,000 annually, depending on usage.
The subcommittee struck the bill from the docket, effectively ending its progress this session.