Midwifery Access California (MACA) representatives, including Holly Smith and other midwives, presented an Alternative Payment Model / Midwifery Payment Model (MPM) that bundles episodes of care to better reimburse the time and continuity midwives provide.

Model design. The model groups care into discrete bundled episodes: an entry‑to‑care bundle (history, physical, initial labs/ultrasound and screening), trimester‑based prenatal bundles, on‑call/availability bundles, triage/labor/birth/postpartum bundles and newborn–parent dyadic care bundles. The APM is designed to capture care coordination, extended visit time, in‑home visits, lactation and behavioral‑health screening, and 24/7 on‑call coverage. Presenters emphasized the model was developed with input from Medi‑Cal managed‑care plans and that sample dollar amounts on the MACA website were intended to be illustrative rather than prescriptive.

Rationale and constraints. Speakers said current billing systems, built for physician episodic care, do not capture the midwifery workload (longer visits, higher visit count and continuity). Presenters estimated that a community midwife often provides about 40 contact hours per client across pregnancy and postpartum (compared with about 9 hours in dominant models), and they argued reimbursement models must recognize time and staff costs so that midwives can be sustainable and accessible.

Stakeholder engagement. Holly Smith and others said several managed‑care plans had participated in conversations and that plans such as LA Care and other state plans have expressed interest. Presenters encouraged midwives and practices to review the APM materials at midwiferyaccessca.org and to participate in ongoing stakeholder discussions.

Why this matters. The APM (MPM) is a potential mechanism to improve access to midwifery care, sustain midwifery practices and align payment with the value of continuity‑centered maternity care. Implementation would require negotiation with payers and likely state or plan‑level pilots to test viability.