Thursday, December 10, 2009

Grassroots Network: “MAMA Is Still on the Hill for You!”

Dear Friends,

Below is the latest from the MAMA Campaign. You’ll find more information about Senator Cantwell’s amendment that mandates Medicaid reimbursement for state-recognized midwives (including CPMs) providing services in birth centers.

The MAMA Campaign Steering Committee is continuing to work hard to get CPMs included as Medicaid providers in the health care reform legislation as Congress nears the finish line for that effort. There are still opportunities – it’s not over yet!

So, please continue to fax and e-mail letters to your Senators and Representatives. They really need to hear from you, their constituents! See some short and easy sample letters at: and more detailed info at: Keep those letters coming – they do make a difference!

And please consider making a donation -- any amount will help!

Susan Hodges “gatekeeper”


From the MAMA Campaign 12/9/09:

MAMA Is Still on the Hill for You!
The US Senate is pushing forward to pass health care reform by Christmas! And MAMA is on the Hill right along with your Congress Members urging that CPMs be included in this bill! This past week we met with several supportive Senator offices in our efforts to accomplish this goal.

MAMA will be working for midwives and mothers on Capitol Hill right up to the final vote on the joint House/Senate bill, expected to take place by the third week in January. The provision to reimburse CPMs in the Federal Medicaid program enjoys wide support in Congress, thanks in large part to your great outreach to your Congress Members. MAMA will continue to leverage this support to take advantage of any and all opportunities to include CPMs in the health care bill throughout the entire process during this congressional session.

MAMA Was So Happy to See You!
Thanks to all of you who joined us last week for our Campaign Webinar: MAMA Has Good News to Share! We had a great time and, from your comments, so did you! Over 50 people participated. The MAMA Campaign Steering Committee shared information about the campaign strategy, infrastructure, accomplishments, and steps forward. Participants were excited to hear details about Senator Maria Cantwell adding language to reimburse CPMs in licensed birth centers into the Senate bill. And we were excited to be joined on the Webinar by our DC lobbyist, Billy Wynne who shared with us his perspective on the Campaign’s progress!

Participants commented:

-“I was able to get a better grasp of the routes which this campaign must navigate- from lobbyist, to the Senate, to the House. I was pleased to hear that great progress is being made.”

-“I am impressed by the continuity of effort put out by everyone and the seriousness it garnered. I thank you immensely.”

-“Congratulations on this tremendous effort!”

-“It is good to know that the MAMA Campaign is run by real people and is alive and well…hearing from each of you was very promising.”

We Especially Enjoyed Answering Your Questions!
Billy and our Steering Committee members were able to answer a number of questions during the Webinar. For those of you who submitted questions that we did not have time to answer during the call, you will be hearing from us soon. And we thought we would answer one of your questions here as well:

I have read Senator Cantwell’s language regarding the payment of provider fees for birth center birth attendants and I don’t see how this language constitutes a the mandate to pay the provider fee. Can you walk us through this?"

Answer: As you will remember from our last few Eblasts, MAMA has had a terrific victory in the last few weeks: under the Senate version of the health care reform bill, Certified Professional Midwives who deliver in birth centers will have their provider fee reimbursed by Medicaid. The provision included by Senator Cantwell to move the ball forward for CPMs is included in the section of the Senate bill that mandates that the facility fee for birth centers be paid by Medicaid. It reads:

"A State shall provide separate payments to providers administering prenatal labor and delivery or postpartum care in a freestanding birth center…such as nurse midwives and other providers of services such as birth attendants recognized under State law, as determined appropriate by the Secretary."

It is typical that mandates for reimbursement by Medicaid be included in Section 1905 of the Social Security Act, and MAMA’s provision to reimburse CPMs in Medicaid is drafted to be included in the SS Act. However, Congress has the power to establish a mandate for coverage of CPM services anywhere, as it has done here with Senator Cantwell’s provision.

The provision is a mandate because it begins with “shall” rather than a “may.” That is the operative word and the operative distinction. There is no discretion in the language to ignore the directive to make the separate provider payments.

And while “As determined appropriate by the Secretary” might make you worry (after all, what if the Secretary says “no?”), don’t: this is very common language that just makes clear that the Secretary of Health and Human Services has discretion in interpreting legislative text. The second sentence of subparagraph (C), makes very clear who the Secretary needs to include in defining “birth attendant”. This phrase regarding the Secretary does not in any way negate the mandate or leave it to the discretion of the Secretary whether or not to make the separate provider payments. The mandate for payment of provider fees has the force of law with this language. We have researched this language with our lobby office where they have many years of experience in drafting key Medicaid legislation for Congress, and we have no concerns about the effectiveness of this provision.

In answer to another question: the use of the term “birth attendant” in this bill is intended to be inclusive, not diminishing, and will in no way undermine the efforts and accomplishments in the state statutes to use the term “Licensed” for midwives.

MAMA Reaches Down Deep to Fund the Campaign!
MAMA supporters are reaching down deep this month to get MAMA to the finish line! While the Senate is working overtime to find their way through the health care reform debate, we are also finding creative ways to support the work of our volunteers and professional lobbyist.

  • State midwifery and consumer groups are spreading the word -- recent gifts have come from Massachusetts, California, and Colorado.
  • A local brewpub in Montana hosted a fundraiser for MAMA on the night before Thanksgiving.
  • A midwifery school director has challenged students and faculty to match her own contribution.
  • A photographer in Maine is taking holiday portraits for midwifery clients and donating 50% of her sales.

Thank you to all of our donors -- we're almost there! Please send a donation today! Click here to donate to MAMA!

If you have any questions, concerns or comments please contact the campaign at

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