The Service Line

MaineHealth’s board confirmed on August 6 what its own numbers argued against, closing a labor and delivery unit that delivers 43 percent more babies than it did in 2019, and five days later a national report showed the closure is the rule, not the exception. MaineHealth’s board voted Thursday, August 6, 2026, to close Labor and Delivery at Lincoln Hospital’s Miles campus in Damariscotta effective December 18, 2026, the 12th Maine maternity unit closure in roughly a decade, a day after a pregnant Newcastle resident sued the health system to block it. The vote landed five days before March of Dimes published “Nowhere to Go: Maternity Care Deserts Across the U.S.” on August 11, finding at least 96 labor and delivery unit closures nationwide across 35 states since January 2024, closures that eliminated the only birthing facility in nearly 60 percent of the affected counties and pushed the maternity care desert share of U.S. counties to roughly one in three. Any operator modeling which units in a region close next should treat a unit’s standalone delivery economics and Medicaid payer mix, not the parent hospital’s overall margin, as the leading indicator, since both were working against Lincoln Hospital’s Miles campus even as its birth volume grew. Confidence: High on the Maine vote and closure date; High on the national closure count and county share, both March of Dimes-published. Sources: MaineHealth board votes to close birthing center at Lincoln Hospital in Damariscotta, Portland Press Herald, Nowhere to Go: Maternity Care Deserts Across the U.S., March of Dimes.

Reimbursement

The clock on the Centers for Medicare and Medicaid Services’ (CMS) plan to run two obstetric billing systems at once in 2027 is now down to five weeks, and neither side has blinked. CMS’s Calendar Year 2027 Medicare Physician Fee Schedule proposed rule, released July 14, 2026, would let payers keep billing legacy bundled global maternity codes through 15 new G-codes running parallel to the new unbundled per-visit codes the American Medical Association finalized for 2027; the American College of Obstetricians and Gynecologists (ACOG) and the OB Hospitalist Group continue to oppose the dual-system option, arguing it splits patients by which billing track their insurer picks and adds administrative burden practices absorb regardless of which system CMS finalizes. Public comments on the rule, CMS-1848-P, close September 14, 2026, leaving practices, hospital systems, and Medicaid managed-care plans about five weeks to get a position on record before the 2027 obstetric (OB) payment architecture locks in, with no public signal yet from CMS on which way it will move. Confidence: High on the rule’s content, dates, and ACOG’s position; Low on which option CMS finalizes. Sources: ACOG Statement on New Maternity Codes in the 2027 Medicare Physician Fee Schedule Proposed Rule, ACOG, ACOG, OBHG Oppose CMS’ Plan For Implementing New Maternity Pay Codes Proposed In 2027 PFS, Inside Health Policy.

Enforcement

A Memphis gynecologic oncologist who reused single-use surgical devices on more than 15,000 patients is going to prison for 20 years, and the bill for those procedures ran to 41 million dollars. Dr. Sanjeev Kumar, who operated the Poplar Avenue Clinic women’s health practice in Memphis, Tennessee, was sentenced July 8, 2026, to 240 months in federal prison after a jury convicted him in January 2026 of adulterating and misbranding medical devices and health care fraud. Prosecutors said he reused adulterated single-use devices in more than 15,000 hysteroscopy-with-biopsy procedures on Medicare and Medicaid patients between September 2019 and April 2024, billing more than 41 million dollars and collecting more than 4.8 million dollars from the two programs. The case is a reminder that the Department of Justice’s medical device adulteration theory, usually associated with reprocessed instruments in general surgery or endoscopy, reaches gynecologic procedure volume too, and that a single high-volume operator can generate criminal exposure on fraud and patient-safety grounds at once. Confidence: High, Department of Justice-announced criminal sentencing following jury conviction. Source: Memphis Gynecologist Sentenced to 20 Years in Prison for Adulterating Medical Devices and Health Care Fraud, U.S. Department of Justice, Western District of Tennessee.

Who’s Buying

No women’s health specific transaction cleared this window. Sun Pharma’s 11.75 billion dollar acquisition of Organon, covered here July 30, remains pending regulatory clearance with no material development since.

Clinical Policy

More than half of U.S. states now pay for doula care through Medicaid, but in the state with the best public data on actual use, fewer than 1 in 100 Medicaid births used one. As of March 2026, 26 states and Washington, D.C. reimburse doula services through Medicaid, per the National Academy for State Health Policy, with Louisiana’s fee-for-service doula benefit, effective January 20, 2026, the most recent addition. A peer-reviewed Health Affairs Scholar study of Virginia’s program found that from January 2022 through December 2024, fewer than 1 percent of Medicaid-covered pregnant patients, roughly 600 people, actually received a covered doula visit, and fewer than half of the state’s 130 Medicaid-enrolled doulas ever billed the program. Researchers pointed to low reimbursement rates, low patient awareness of the benefit, and a doula workforce unevenly distributed across a state’s Medicaid regions, the same barriers cited in multi-state implementation reviews; any Medicaid managed-care plan or state agency counting a doula benefit as a maternal-outcomes lever should treat provider enrollment and patient awareness, not the coverage decision itself, as what actually determines whether the benefit does anything. Confidence: High on Virginia’s utilization data, peer-reviewed; Medium on how representative Virginia’s gap is nationally. Sources: State Trends in Medicaid Coverage of Doula Services, National Academy for State Health Policy, Doula services for Medicaid beneficiaries in Virginia: access, utilization, and policy lessons, Health Affairs Scholar.

The Operator Metric

The number to track this week: 8,200, the shortage of certified nurse-midwives the profession’s own workforce study says the country has right now, in a country where 56 percent of counties have zero. The American College of Nurse-Midwives’ Midwifery Workforce Study puts the current U.S. midwife workforce at roughly 14,000 against a need of about 22,000 to meet the World Health Organization’s minimum staffing benchmark of 6 midwives per 1,000 live births, and separately finds 56 percent of U.S. counties have no nurse-midwife at all. A peer-reviewed 2025-2035 workforce projection using the Health Resources and Services Administration’s Health Workforce Simulation Model separately found that by 2035, all but six states will have an inadequate obstetrician-gynecologist supply, with the steepest shortfalls in nonmetropolitan counties. Because staffing, not licensed bed capacity, is now the binding constraint on keeping a labor and delivery unit open, any OB/GYN group, hospital system, or management services organization building a 2027 staffing or compensation budget should model recruitment cost and locum reliance against these numbers before assuming last year’s staffing ratio holds. Confidence: High, the American College of Nurse-Midwives’ own workforce study and a peer-reviewed Health Resources and Services Administration model analysis. Sources: Midwifery Workforce Study, American College of Nurse-Midwives, Projected Shortages and Distributional Challenges of Obstetrician-Gynecologists in the United States, 2025-2035, PubMed.