State House News Service: Negotiators Agree On Maternal Health Bill

By Alison Kutznitz | Originally published by State House News Service

STATE HOUSE, BOSTON, AUG. 14, 2024.....Pregnant people and those who recently gave birth could gain access to expanded care options in Massachusetts under compromise maternal health legislation released Wednesday.

The conference committee accord (H 4999), which lead House negotiator Rep. Marjorie Decker filed just after 3:30 p.m. Wednesday, is the first big piece of legislation to emerge from closed-door talks after lawmakers ended formal sessions this month with major loose ends.

Decker told reporters the House will take up the bill on Thursday during an informal session, where recorded votes are not allowed and there is usually no debate. All six conferees signed the conference report, said Decker, co-chair of the Public Health Committee.

"I'm not sure there's a whole lot of compromise," Decker said when asked about the highlights of the compromise. "It was really just taking the strengths of each bill, which they were so closely aligned."

Decker was not joined by any other conferees at the House Clerk's office, though her mother -- a Cambridge constituent -- was there.

The House and Senate had passed largely similar omnibus maternal health bills enabling certified professional midwives to be licensed in the commonwealth, eliminating regulatory barriers for opening birth centers for low-risk pregnancies, boosting access to postpartum depression screenings, and expanding resources for perinatal mood and anxiety disorders, among other parameters.

The compromise bill allows lactation consultants to be licensed, a policy included in the House version but not the Senate. The agreement also requires insurance coverage of donor human breast milk or milk-derived products, bolsters MassHealth coverage of doula care, and strengthens oversight of ultrasound services.

"I think most importantly, what this bill does is it really allows us to take a very strong, comprehensive approach to maternal health," said Decker, who noted the bill is rooted in recommendations from the Special Commission on Racial Inequities in Maternal Health. "I think to the House leadership, to myself, and to our colleagues on the other side, that this was not going to be a commission report that wasn't also acted on, so I'm really proud."

The Cambridge Democrat added the bill "goes a long way in providing a lot more autonomy, and choices, and care, and coverage for maternal health."

Decker and lead Senate negotiator Sen. Cindy Friedman issued a joint statement, saying the bill "expands coverage for mental health care and services provided by midwives and doulas, creates a pathway for licensure for certified professional midwives and lactation consultants and bolsters out-of-hospital delivery options for our residents."

In the early afternoon hours of July 31, Decker and conferee Rep. Mike Moran were poised to be appointed to the maternal health conference committee, but lamented they were still awaiting papers from the Senate to jumpstart negotiations. The House unanimously passed its maternal health legislation (H 4785) on June 20, while the Senate unanimously approved its version (S 2899) on July 30.

After lawmakers gaveled out on Aug. 1, Moran told the News Service the maternal health conference committee had not managed to meet yet. Decker offered a more optimistic outlook last week, saying negotiators were "very, very close."

Advocates and lawmakers have pitched the bills as a response to worsening maternal health outcomes that are disproportionately impacting people of color. The rate of severe maternal morbidity nearly doubled from 2011 to 2020, with Black individuals experiencing the highest rate of complications from pregnancy or delivery.

"The Massachusetts Legislature clearly understands that the right to reproductive health care, including care for pregnancy, delivery, miscarriage care, and abortion care, is not a realized right unless every person is able to safely access that care with dignity," Rebecca Hart Holder, president of Reproductive Equity Now, said in a statement Wednesday. "By empowering midwives and removing burdensome barriers to the opening of freestanding birth centers, this legislation can deliver real advancements in birthing justice and work to address a worsening maternal health crisis in the Bay State. An agreement on this legislation signifies that our legislature is ready to turn a corner in the fight for maternal health equity in Massachusetts, and we look forward to getting it across the finish line together."

Department of Public Health Commissioner Dr. Robbie Goldstein called the maternal health bill a priority Wednesday morning.

"While you may have seen in the news that many of our public health priority bills did not make it through last-minute conference negotiations, including comprehensive maternal health and substance use disorder bills, we're confident that the work we did to foster greater understanding and acceptance on issues such as overdose prevention centers, workforce supports for certified professional midwives and recovery coaches, and the possibility for a non-punitive pathway for substance-exposed newborns, puts us in a particularly strong position to move these issues forward," Goldstein told the Public Health Council.

Top Democrats have said they intend to keep working on other major bills during informal sessions, which under legislative rules are often limited to non-controversial matters. Decker, without invoking specific legislation, said conversations have continued in recent weeks.

"I can only speak for my colleagues in the House. They are still working on conference committee issues that are before them," Decker said. "Those conversations haven't stopped."