Caitlin Hainley, left, wants to open a birth center in Iowa, but said the state’s certificate-of-need law has been a barrier.
Photo courtesy Des Moines Midwife Collective
After years of work, Katie Chubb, RN, thought she would finally be able to open a birth center in Augusta, Georgia.
The Georgia Department of Community Health had ruled that the perinatal health care service was needed in a region considered a maternity care desert. She had lined up a maternal fetal doctor and other qualified staff. She had chosen a building site.
But Chubb’s certificate-of-need application was ultimately denied by state officials.
Across the U.S., certificate-of-need laws control the number of local health services — including nursing homes, hospitals, mental health treatment centers, health transportation providers and clinics — that are available in a community. The laws have been around for decades, but are facing new scrutiny.
In the 1970s, Congress pressed states to pass certificate-of-need laws, which aim to reduce duplicative services and costs, by withholding federal funding. Congress dropped the requirement in the 1980s. Even so, 35 states and the District of Columbia still have the laws in place. Opponents say the laws prevent needed health services from opening in communities.
One argument in support of certificate-of-need laws is that they keep rural hospitals open by limiting competition. But a 2024 study in the Southern Economic Journal found otherwise. Researchers looked at two decades of data on health service outcomes, finding states without the laws do not experience additional hospital closings in rural areas.
“If the goal is to provide increased health care access to people living in rural areas, then we should repeal those laws,” Vitor Melo, PhD, a fellow at the Initiative on Enabling Competition in Healthcare at the University of Chicago and lead author of the study, told The Nation’s Health.
In recent years, more states have amended their certificate-of-need laws. In 2023, South Carolina rewrote its policy, though it excluded nursing homes, home health agencies and new hospitals. Also that year, West Virginia canceled certificate-of-need requirements for birthing centers and general hospital services, though efforts to repeal the law outright received pushback from the state’s legislature.
In Iowa, one-third of counties are considered maternal care deserts, and more than 60% of rural hospitals in the state have no labor or delivery centers.
Noting a need for maternal care in the state, Caitlin Hainley, DNP, ARNP-CNM, co-opened in 2021 the Des Moines Midwife Collective, a home birth midwifery practice and lactation clinic based in Iowa’s capital. The collective is the only midwifery service within 250 miles of Des Moines that accepts insurance, including Medicaid, she said.
Hainley wants to transition her business model from home births to a free-standing birth center. But Iowa’s certificate-of-need law, while accepting of home birth services, bumps up against her vision of a brick-and-mortar facility.
“Birth at an independent, free-standing midwifery center is completely different than a hospital birth,” Hainley told The Nation’s Health. “There’s room and a need for both.”
In Georgia, Chubb said she has not given up on the Augusta center. She has switched her focus from the courts to the legislative arena, lobbying to repeal Georgia’s certificate-of-need law.
“I told my board when we started that it was going to be a 10-year battle,” she told The Nation’s Health.
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- Copyright The Nation’s Health, American Public Health Association
