Statement from the American Nurses Association\California on AB 55 (Bonta) Freedom to Birth Act – As Amended 4/09/2025- SUPPORT

AB_55_Asm_Approps_Support_Apr2025.pdf

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April 14th, 2025

The Honorable Mia Bonta

1020 N Street, Suite 390

Sacramento, CA 95814

RE: AB 55 (Bonta) Freedom to Birth Act – SUPPORT As Amended 4/09/2025

Dear Assemblymember Bonta:

On behalf of the American Nurses Association\California (ANA\C), we are proud to support AB 55 (Bonta). ANA\C is a bi-partisan professional nursing organization representing the interests of more than 500,000 licensed registered nurses in California. Our mission is to optimize nursing contribution to the health and well-being of individuals, families, and communities. As a state-level professional advocacy organization, ANA\C has been extensively involved in legislative efforts supporting many bills that became California’s

laws and are currently assisting in making California a place of Nursing Excellence.

AB 55 (Bonta) would streamline licensing requirements for Alternative Birth Centers (ABC), to increase access to perinatal care for California families. According to CalMa1ers, 56 hospitals in California have stopped a ending births since 2012 (1). As a result, large areas of California are without access to

birthing facilities or perinatal care providers (2). The absence of access to perinatal care has disproportionately harmed California’s low-income, Black, Latinx, Indigenous, and rural communities, which experience higher rates of adverse birth outcomes. When maternity wards close birthing people receive less prenatal care, and rates of preterm birth increase (3). Birth centers provide a safe perinatal

care option for low-risk birthing people while also addressing maternity care deserts. Birth centers specialize in childbirth and care for patients with uncomplicated pregnancies in an environment that is less restrictive and more home-like than a hospital. In addition, birth centers have an established safety record, as documented in studies of birth center care in the United States. In 2018, the Centers for Medicare & Medicaid Services published findings from their Strong Start for Mothers and Newborns initiative which evaluated the effectiveness of three different models of care, including birth centers, to provide enhanced prenatal care to Medicaid beneficiaries.

Birthing people who received prenatal care at a birth center had half the national rates of preterm birth, low birth weight, and cesarean sections (4). Additionally, recent studies in Washington found that delivery in a freestanding birth center for low-risk individuals is as safe as hospital delivery (5). Unfortunately,

outdated and obstructive licensing requirements in California are impeding birth centers’ ability to obtain licensure, presenting a significant barrier to providing access for birthing people, including those designed to serve low-income and communities of color (6).

Requirements for birth center owners to enroll in programs that unnecessarily duplicates current practices or sets arbitrary proximity standards have not proven to increase safety or optimal outcomes. A half of California births are paid for by Medi-Cal (7). However, to receive Medi-Cal reimbursement, California birth centers must meet stringent licensing requirements. Increasing the potential number of

birth centers eligible for Medi-Cal payment will positively impact underserved communities by ensuring more equitable access to quality birthing options while also reducing Medi-Cal costs (8).

AB 55 (Bonta) will address the maternity care crisis in California by streamlining licensing requirements for ABCs and increasing access to additional birthing options for California’s families. For these reasons,

ANA\C is proud support this important legislation and thanks you for your leadership on this important

issue.

Respectfully,

Dr. Marketa Houskova, DNP, MAIA, BA, RN

Chief Executive Officer

__________________________________________________________________________

References:

1) Hwang, K., Yee, E., & Ibarra, A. B. (2024, September 16). California’s maternity care crisis is worsening as

Newsom decides on bills to slow closures. CalMatters. hNps://calmaNers.org/health/2024/09/new-maternity-care-

closures/

2) Hwang, K. (2024, August 26). They delivered 5,600 babies. They blame California rules for putting them out of business. CalMatters. hNps://calmaNers.org/health/2024/08/birth-center-closures/

3) Kozhimannil KB, Hung P, Henning-Smith C, Casey MM, Prasad S. Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States. JAMA. 2018;319(12):1239 1247.doi:10.1001/jama.2018.1830

4) Centers for Medicare & Medicaid Services. (2018, October). Strong Start for Mothers and Newborns

evaluation: Year 5 project synthesis (Volume 1: Cross-cutting findings).

hNps://downloads.cms.gov/files/cmmi/strongstart- prenatal-finalevalrpt-v1.pdf

5) Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the

United States hNps://jamanetwork.com/journals/jama/fullar[cle/2674780

6) Grigoryants, O. (2021, September 5). Birth centers grow in popularity, but owners say it’s difficult to qualify for state license. Los Angeles Daily News. News. hNps://www.dailynews.com/2021/09/05/birth-centers-grow-in-

popularity-but-owners-say-its-difficult-to-qualify-for-state-license/

7) In 2019, there were 440,395 births in California: 212,395 were paid for by Medi-Cal, and 228,000 were paid by non-Medi-Cal sources. hNps://data.ca.gov/dataset/medi-cal-birth-sta[s[cs-by-select-characteris[cs-and-

california-resident-hospital-births/resource/a0f6c606-06f5-4479-84bd 7f47546beaa7

8 )Medicaid paid $2,010 less per parent through birth and the year following for each mother-infant pair than for other Medicaid participants with similar characteristics.

hNps://www.cms.gov/priori[es/innova[on/files/reports/strongstart- prenatal-fg-finalevalrpt.pdf