Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Walter J. Jones

Second Advisor

James S Zoller

Third Advisor

Mark Mellottt


This research focuses on an access to care issue that evaluates the perceived barriers birthing centers and their clients experience with processing insurance or paying cash. In 2010, the Affordable Care Act (ACA) ensured that State Medicaid Programs cover maternity care provided in freestanding birth centers licensed or otherwise approved by the State. The lack of policies impacts birthing centers and their clients, disproportionately minority and medically underserved women. Primary and secondary data was gathered to evaluate outcomes, quantitatively and qualitatively. An anonymous nationwide nine question survey was distributed via email to nearly 300 American Association of Birth Centers (AABC) accredited facilities to explore their billing methods. Though several state Medicaid programs reimburse all types of midwives and birthing centers, the reimbursement is not equal. To ensure quality of care remains high and the facility remains open several centers have to decline service to Medicaid recipients. In 2014 Medicare & Medicaid Research Review published an article about potential cost savings for maternity care in a birthing center. Midwifery led maternity care in birthing centers may improve birth outcomes for Medicaid recipients, minorities and low income families, while improving mortality rates nationally.


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