Senate Bill 536, the Birth Freedom Act, would expand coverage and reimbursement for maternity care related to births planned or occurring at home or in birthing centers. It amends North Carolina insurance law to require health benefit plans that include maternity coverage to cover all necessary services and care for those births when supervised by a qualified healthcare provider, and it applies the same general mandate to the State Health Plan. The bill also directs the Department of Health and Human Services to ensure Medicaid beneficiaries have access to those services and to reimburse them in the same manner as other maternity coverage.
The bill further appropriates $150,000 in nonrecurring General Fund money to the Department of State Treasurer for the 2025-2026 fiscal year to increase access to birthing-center maternity care under the State Health Plan. The State Health Plan Board of Trustees is instructed to consider incentives that are intended to produce cost savings, including subsidies of up to $1,500 for birthing-center maternity care and reimbursement rates at no less than 90% of the average commercial hospital rate for similar services. Most insurance-related changes take effect October 1, 2025, while Medicaid access changes are to be added as soon as possible on or after July 1, 2025.
Impact
The bill would modify Chapter 58 of the North Carolina General Statutes by expanding the required scope of maternity coverage in health benefit plans to include home births and birthing-center births under qualified supervision. It also updates the statutory provisions governing the State Health Plan so that those maternity coverage requirements apply there as well, and it creates a new funding and policy directive for the State Health Plan to encourage use of birthing centers. In addition, it imposes an administrative mandate on DHHS to provide Medicaid coverage and reimbursement for these services, affecting Medicaid beneficiaries, insurers, the State Health Plan, birthing centers, and maternity care providers.
Sentiment
Based on the bill text alone and the absence of recorded committee debate or votes, the measure appears to be framed positively as an access-to-care and birth-choice bill. Its title and provisions suggest support for broader maternity options, especially for home births and birthing centers, and for reducing financial barriers to those services. Because there are no transcripts or vote records provided, there is no documented legislative sentiment beyond the bill’s apparent policy intent.
Contention
The main likely point of contention is cost and mandate scope: insurers, the State Health Plan, and state budget writers may scrutinize the requirement to cover additional maternity services and the Medicaid reimbursement obligations. Another possible issue is whether the bill’s coverage standards, including reimbursement at 90% of commercial hospital rates and subsidies up to $1,500, are sufficient or appropriate to achieve the stated access goals. Supporters would likely emphasize maternal choice, access to midwifery/birthing-center care, and parity in maternity coverage, while critics may focus on fiscal impact, implementation details, and whether home-birth coverage raises safety or utilization concerns.