Section 1.

Directs the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB) to seek approval from the Centers for Medicare and Medicaid Services (CMS) to implement Medicaid coverage for certain doula services. Requires DHB, in collaboration with DHHS’s Division of Public Health (DPH) to develop the parameters of services to be covered, update applicable coverage policies, and determine credentialing requirements. Provides a list of education and experience considerations for implementing credentialing requirements.

Specifies that DHB must implement coverage as soon as possible after receiving approval from CMS. Requires DHB to provide a report no later than March 1, 2027, to the specified NCGA committee regarding the Medicaid coverage and estimated recurring costs to the State.

Section 2.

Appropriates $1,000,000 in recurring funds and associated receipts beginning with 2026-27 from the General Fund to DHB to implement the Medicaid-related changes. Appropriates an additional $550,000 in recurring funds beginning with 2026-27 to DHB for support services and technical assistance to the doula workforce. Effective July 1, 2026.

Section 3.

Enacts new Article 10B, Certified Professional Midwives, to GS Chapter 90. Prohibits any person from practicing or offering to practice midwifery without a Certified Professional Midwife (CPM) license as provided in new Article 10B. Exempts the following circumstances from the licensure requirement: (1) an individual approved to practice as nurse midwife under Article 10A (Midwifery Practice Act); (2) a physician licensed to practice medicine; (3) the performance of medical acts by a physician assistant or nurse practitioner when performed according to Board rules, (4) the practice of nursing by a registered nurse as allowed under Article 9A (Nursing Practice Act), and (5) the rendering of childbirth assistance in emergency situations.

Includes definitions applicable to Article 10B. Defines midwifery as the provision of primary health or maternity care to childbearing people and infants.

Creates a seven-member North Carolina Council of Midwives (Council), with members appointed by the Secretary of Health and Human Services (Secretary; DHHS). Provides for initial members to be appointed on or before October 1, 2026, or within three months of the Article becoming law, whichever is later. Details Council member requirements and term limits and includes provisions for compensation, meeting procedures, and Council administration. Directs the Council to adopt rules within one year of the initial meeting to implement the Article. Enumerates 12 powers and duties of the Council, in consultation with the Division of Health Service Regulation (DHSR) of DHHS and with guidance from the National Association of Certified Professional Midwives Standards of Practice, including rulemaking, licensing, and disciplinary authority. 

Lists five requirements for licensure as a certified professional midwife, including completion of an application and payment of required fees, and completion of all required educational and clinical training and earning the national Certified Professional Midwife certification credential awarding by an accredited midwifery certification agency.

Lists nine responsibilities of a licensed CPM, including the responsibility to provide care for the healthy client who is expected to have a normal pregnancy, labor, birth, and postpartal phase in the setting their choice; the responsibility to order routine antepartal or postpartal screening or lab analysis at a licensed lab or testing facility; and the responsibility to instruct the parents about all State-required newborn screening requirements. Directs a CPM licensed under Article 10B to display the license at all times in a conspicuous place where the midwife is practicing. Sets forth provisions for biennial license renewal, periods of lapsed licensure, and granting inactive status. Authorizes the Council to grant a license to a person residing in North Carolina licensed, certified, or registered to practice as a CPM in another jurisdiction if that jurisdiction's standards are substantially equivalent and the person submits an application and required fees. Directs the Council to establish a formulary of drugs and devices appropriate to CPM care from which licensed CPMs are limited to dispensing from, subject to applicable state and federal laws and recordkeeping requirements. Directs the Council to set all fees under Article 10B and to pay all expenditures out of funds from the fees or other funds. Allows the Council to discipline applicants or licensees, after a hearing, under seven specified circumstances.

Authorizes the Council to apply to superior court to enjoin violations of Article 10B. Provides that no health care provider will be liable for an injury to a woman or infant arising during childbirth and resulting from an act or omission by a licensed CPM.

Effective October 1, 2026.

Section 4.

Enacts Part 7 to Article 6 of GS Chapter 131E, the “Birth Center Licensure Act,” to establish licensing requirements for birth centers. Defines birth center as a facility licensed for the primary purpose of performing normal, uncomplicated deliveries that is not a hospital or ambulatory surgical facility and where births are planned to occur away from the mother's usual residence following a low-risk pregnancy (defined). Tasks DHHS with reviewing and revising as necessary the Freestanding Birth Center Fee Schedule (Schedule) every three years in new GS 131E-154.20.  Requires, in GS 131E-154.21, DHHS to inspect birth centers as it deems necessary to investigate unexpected occurrences involving death or serious physical injury and reportable adverse outcomes.  Specifies that birth centers are subject to inspection by DHHS at all times. Allows for public disclosure of information received by DHHS or the NC Birth Center (Commission), except where doing so would violate laws pertaining to patient records and confidentiality.

Establishes the seven-member Commission in DHHS to (1) adopt rules establishing standards for birth centers and (2) to review and make recommendations to DHHS about whether to approve or disapprove of birth center license applications. Provides for appointees, vacancies, terms and term limits, removal by the Governor for misfeasance, malfeasance, or nonfeasance, compensation, quorum, and clerical and support services. Instructs the Commission to adopt rules on accreditation, risk status procedures, mandating second trimester ultrasounds and targeted ultrasounds, patient transfers, and reporting, including on unexpected occurrences involving death or serious physical injury and any other adverse outcomes. Requires DHHS to enforce new Part 7 and the Commission’s rules. Authorizes release of confidential or nonpublic information to any health care licensure board in this State or another state or to DHHS personnel with investigative or enforcement authority over licensees in new GS 131E-154.25.

Adds GS 131E-154.17 to new Part 7, requiring birth centers to be licensed by DHHS. Provides for an application, one-year license, and posting of the license. Allows birth centers that (1) are operating in this State on the date the act becomes effective, (2) are accredited by the Commission for the Accreditation of Birth Centers (CABC), and (3) remain continually accredited to continue operations as the Commission is constituted and promulgates permanent rules. Provides for application process for those birth centers after that occurs. Authorizes DHHS, including the Secretary or designee, to take adverse action on a license in new GS 131E-154.18. Allows a birth center to challenge those actions under the contested case provisions of the APA. Prohibits a birth center from rendering the following services: (1) surgical procedures outside of those normally accomplished outside of an uncomplicated birth, to be determined by the Commission; (2) abortions; (3) general or conduction anesthesia; and (4) a vaginal birth after cesarean (VBAC) or trial of labor after cesarean (TOLAC). Effective one year after the rules promulgated by the North Carolina Birth Center Commission are adopted and applies to licenses granted on or after that date.

Makes it a Class 3 misdemeanor for a person to own, in whole or in part, or operate a birth center without a license, subject to a $50 fine for a first offense and up to $500 fines for subsequent offenses. Applies to offenses committed on or after December 1, 2026.

Directs DHHS, by October 1, 2026 to review and, as necessary, revise its current Freestanding Birth Center Fee Schedule to ensure that (1) the fees are sufficient to cover the costs of providing intrapartum, birth,  postpartum, and initial newborn care and (2) the cost for any State-mandated newborn screening is reimbursed at no less than the cost of the screening. Tasks DHHS with developing a licensure application. Requires the initial Commission appointments to be made not later than 60 days after the act’s effective date. Provides for initial staggering of terms.