What You Need to Know About HB 224 - Regulating the Practice of Certified and Licensed Midwives

What is House Bill 224?

• House Bill 224 introduces an optional licensing framework for midwives (CMs, CPMs, and CNMs) in Ohio. Traditional or lay midwives may continue practicing without a license, provided informed consent and a limited scope of care Ohio House of RepresentativesOhio House of Representatives.

• Establishes a midwifery advisory committee to oversee training, supervision, reporting standards, and scope of practice

• Requires systematic reporting of critical outcomes (e.g. maternal or neonatal mortalities, transport details) to support quality improvement and safety tracking

Current Situation in Ohio

Only Certified Nurse‑Midwives (CNMs)—licensed APRNs—are officially recognized by the state. They can practice in hospitals, birth centers, and sometimes attend home births, with Medicaid and private insurance reimbursement.

Certified Professional Midwives (CPMs) and Certified Midwives (CMs) are not licensed in Ohio. They operate in a legal gray zone, typically attend home births, get paid out-of-pocket, and lack billing privileges or formal integration into the healthcare system.

What Would Change for Families with Passage of HB 224?

Greater access & choice

• Expanded availability of licensed CPMs and CMs, especially in maternity care deserts like rural Ohio counties, where hospital obstetric services may be unavailable .

• More families would have legal access to home birth or birth center care under credentialed providers.

Insurance coverage

• Licensed midwives would likely be eligible for Medicaid and private insurance reimbursement, reducing out-of-pocket costs and broadening affordability.

Safety & quality

• Mandatory training standards, certification, and outcome reporting aim to ensure consistent high-quality care and improved safety transparency.

• Routine data collection may help identify areas for improvement in home or community birth settings.

Integration into healthcare

• Licensed midwives would work more seamlessly with hospitals, birth centers, and OB‑GYNs, improving coordination and timely transfers when needed.

• Traditional midwives, still allowed to practice without licensure, would remain out of formal integration unless they choose licensure.

Changes for Midwives & Practices

Certified Nurse‑Midwives (CNMs)

• No major change—CNMs remain licensed via nursing boards, eligible for reimbursement; integration already exists—but they may see increased collaboration with CPMs/CMs.

Certified Midwives (CMs) and Certified Professional Midwives (CPMs)

• Would gain official Ohio licensure, access to insurance billing, ability to attend more births officially (hospital, birthing center, or home).

• Enter formal regulatory structure under an advisory board—not just under the Board of Nursing—which may help preserve the midwifery model of care.

• Required to meet training standards (including breech, pharmacology courses), certification or equivalency benchmarks, and ongoing continuing education.

Traditional / Lay midwives

• Can continue unlicensed practice, but losing licensure eligibility may limit access to institutional settings or referrals. They must operate under informed consent and limited scope intentionally defined by the law.

Broader Impacts on Ohio Healthcare

An increased midwifery workforce, especially outside hospitals, could potentially alleviate strain on institutions and improve maternal/infant outcomes across the state. Maternal health equity benefits may also increase—including expanded access in underserved areas, culturally competent care, reduced cesarean and intervention rates as seen in midwifery-led models elsewhere .

We may also see a stronger quality oversight and standardized care pathways, built on mandatory reporting and training criteria/

What You Should Know

• Legislation is pending—HB 224 is under review in the Ohio House Health Committee (introduced April 7, 2025) and could evolve as amendments are made Friends of Midwives.

• Licensure is optional. Practitioners may choose it or continue under the traditional midwifery model.

• Informed consent remains key: lay midwives will still need to clearly articulate the limits of their scope, as unregulated practice continues to raise concerns around insurance, liability, and collaboration.

• Families interested in home birth or midwifery care should ask about certification and any intentions to seek licensure, to understand insurance and legal protections.