Bill Text: NJ S4228 | 2026-2027 | Regular Session | Introduced
Bill Title: Establishes "Targeted Midwifery Workforce Development Act"; appropriates $12 million.
Sponsorship: Partisan Bill (Democrat 5)
Status: (Introduced) 2026-05-14 - Introduced in the Senate, Referred to Senate Labor Committee [S4228 Detail]
Download: New_Jersey-2026-S4228-Introduced.html
Sponsored by:
Senator BRITNEE N. TIMBERLAKE
District 34 (Essex)
SYNOPSIS
Establishes "Targeted Midwifery Workforce Development Act"; appropriates $12 million.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning workforce development for midwives, supplementing Title 34 of the Revised Statutes, and making an appropriation.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known and may be cited as the "Targeted Midwifery Workforce Development Act."
2. The Legislature finds and declares that:
a. New Jersey has a population of over nine million people, with Black residents making up approximately 13 percent of the population.
b. The New Jersey Department of Health has found that as of 2021, Black infants in New Jersey have a higher infant mortality rate than white infants, specifically finding that Black infants are 3.5 times more likely to die before their first birthday than white infants.
c. The New Jersey Department of Health has found that as of 2023, the rate of infant mortality for Black babies is 8.8 per 1,000 live births versus 2.1 per 1,000 live births for white babies. This disparity means that despite a low overall infant mortality rate in the State, the State infant mortality rate for Black babies is higher than the national overall infant mortality rate of 5.4 per 1,000 live births.
d. In its Maternal Health Fact Sheet, the Network for Public Health Law cited data from 2022 finding that the infants of Black parents in the top of the income distribution had a rate of low birthweight and preterm birth 1.5 times higher than the infants of white parents in the bottom of the income distribution, and that infant mortality for Black infants in the top decile of the income distribution was 23 percent higher than that of white infants in the bottom decile of the income distribution.
e. According to the Centers for Disease Control, Black women are three times more likely to die from a pregnancy-related cause than white women.
f. In its 2016-2018 review of maternal mortality, the New Jersey Department of Health found that the pregnancy-related maternal mortality rate for Black, non-Hispanic women was 39.2 deaths per 100,000 live births, which was 6.6 times higher than the rate for white, non-Hispanic women (5.9 per 100,000 live births).
g. The Network for Public Health Law cited data that, compared to white women, Black women more frequently reported: having their pain minimized or ignored; having still births; unfair treatment and disrespect by providers because of their race; no patient autonomy during pregnancy, labor, and delivery; and pressure to have a cesarean section.
h. According to the National Partnership for Women and Families, Black women have a heightened risk of pregnancy-related death irrespective of their incomes and education levels, and the Centers for Disease Control has reported that a Black woman with a with a completed college education or higher is 1.6 times as likely to die from a pregnancy-related death as a white woman with less than a high school diploma.
i. The Centers for Disease Control has found that rates of breastfeeding initiation, duration, and exclusivity are 10-20 percentage points lower among Black infants, compared with white infants, and that the rate of implementation of evidence-based maternity care practices supportive of breastfeeding is lower among maternity care facilities in neighborhoods with larger Black populations.
j. In 2022, the preterm birth rate among Black women was about 50 percent higher than white or Hispanic women, according to the Centers for Disease Control, and that preterm birth contributes to infant mortality and disability.
k. The New Jersey Department of Health found that in 2022, approximately 61 percent of Black women in New Jersey receive early and consistent prenatal care compared to approximately 83 percent of white women.
l. The Commonwealth Fund found that in 2019 the total cost of maternal morbidity including medical expenses, lost productivity, and long-term care needs amounted to $32.3 billion nationwide for each cohort of births, covering the period from conception to the child's fifth birthday.
m. The New Jersey Health Care Quality Institute 2022 midwifery report recommended improving continuity of care with enhanced collaboration, expanding education and training opportunities, and addressing systemic inequities to ensure equitable access to midwifery services to strengthen maternal healthcare quality across the State.
n. An article published by the Harvard T.H.Chan School of Public Health entitled "Strategies to Improve Black Maternal Health Outcomes and Advance Health Equity" recommended diversifying the medical workforce, training staff to be culturally competent and empathetic, and increased transparency and accountability for clinicians would improve health outcomes for pregnant Black women.
o. The Center for American Progress recommends access to culturally congruent care to increase favorable birth outcomes, reduce infant mortality, and improve overall health for historically marginalized residents throughout the nation.
p. The New Jersey Higher Education Student Assistance Authority found that the State will face a shortage of 11,400 nurses by 2030, as well as shortages for many other workers in the healthcare industry.
q. Investing in workforce development programs targeting populations who have been disproportionately affected by New Jersey's maternal health crisis allows for increased access to well-paying jobs for marginalized communities, as well as improving health outcomes for Black women and infants.
r. Certified Professional Midwives are philosophically important in advancing maternal care because they are trained to provide comprehensive care throughout pregnancy, labor, and postpartum, emphasizing the natural process of birth and minimizing unnecessary medical interventions.
s. The training and integration of certified professional midwives into the healthcare system would be a transformative step toward reducing maternal morbidity and mortality. By supporting certified professional midwives, the State can promote culturally congruent, accessible care that empowers women, respects their choices, and improves overall health outcomes.
3. As used in this act:
"Commissioner" means the Commissioner of Labor and Workforce Development.
"Cultural congruence" means a clinician or provider shares the same ethnicity and similar life experiences as the client, reducing the likelihood of negative health outcomes by ensuring that interactions with patients are reflective of the caregiver's respect and understanding of culture, beliefs, values, and morals expressed by the patient. This standard for interactions ensures that patients are more likely to seek care and achieve a positive health outcome because they feel comfortable developing a relationship with a treatment provider who has had similar life experiences and understands what it is like to be in their place.
"Department" means the Department of Labor and Workforce Development.
"Family support" refers to the annual cost of childcare, housing, food, transportation, healthcare, and other living costs in addition to a certified education program's annual cost.
"Historically marginalized community" refers to a group in New Jersey who has been relegated to the lower or peripheral edge of society while being denied full participation in or access to mainstream societal, political, or economic benefits because of systemic adverse legal or policy decisions.
"Midwife" refers to a person practicing midwifery who attends a woman in childbirth as a midwife, or advertises as such, by signs, printed cards or otherwise in accordance with R.S.45:10-1 et seq.
"Nontraditional student"
refers to a student who has professional and personal demands on the student's
life that make it challenging for the student to meet the student's academic
goals.
4. a. To address the disparate health outcomes for Black women and infants, and to address the increasing need for healthcare workers in the State, there is hereby established in the Department of Labor and Workforce Development, the "Targeted Workforce Development Program for Midwifery Training," or "program." The purpose of this program shall be to:
(1) educate individuals representing historically marginalized communities directly impacted by maternal health disparities on the benefits of a career as a certified midwife in New Jersey;
(2) reduce the negative maternal health outcomes caused by underrepresentation in the health care space by increasing cultural congruence in the midwifery field in underserved communities;
(3) build out sustainable community-led alternatives and supports for individuals representing historically marginalized communities through professional hiring and staff retention; and
(4) attract a larger pool of candidates representing historically marginalized communities by providing financial support and resources necessary in order to pursue and complete midwife certification.
b. The department is authorized to obtain, accept, and utilize resources for the "Targeted Workforce Development Program for Midwifery Training" as may be, or may become, available from appropriate State, federal, and non-governmental sources of funding for employment, training, and educational purposes, including the Workforce Development Partnership Fund created pursuant to section 9 of P.L.1992, c.43 (C.34:15D-9), the "Supplemental Workforce Fund for Basic Skills" established pursuant to section 1 of P.L.2001, c.152 (C.34:15D-21), or funds available pursuant to the "Workforce Innovation and Opportunity Act," (29 U.S.C. s.3101 et seq.). The department may work with a midwifery affiliated or accredited college, university, certificate program, and apprenticeship program in or out of state to carry out the aims of this act.
c. The program shall address maternal health and economic disparities by:
(1) incentivizing career paths in priority order as follows to serve in historically marginalized communities:
(a) Certified Professional Midwives (CPM); and
(b) Certified Nurse Midwives (CNM) and Certified Midwives (CM);
(2) creating loan forgiveness programs for applicants who belong to historically marginalized communities disproportionally affected by the maternal health crisis and have expressed a commitment to working in these historically underserved communities for a period no less than five years upon completion of the program;
(3) providing competitive salaries or signing bonuses to attract and retain medical professionals representing historically marginalized communities;
(4) providing childcare and housing assistance to reduce financial burdens and make relocation more attractive;
(5) providing grants to community-led birthing hubs and wellness centers to hire and retain midwives from historically marginalized communities;
(6) creating mentorship networks to connect midwives from historically marginalized communities with established practitioners in underserved communities;
(7) establishing community partnerships to build collaborations between medical schools, hospitals, and community-led birthing hubs and wellness centers to create pipelines for midwives representing historically marginalized communities; and
(8) providing training and resources for midwives to develop as entrepreneurs.
d. The program shall include:
(1) information on the benefits of becoming certified as a midwife and practicing in New Jersey;
(2) a general summary of the requirements to become certified as a midwife in New Jersey, including, but not limited to, information on the application process, curriculum, and certification requirements;
(3) the creation of a fund for the financial support throughout the course of studies, including but not limited to a stipend, reimbursements, and other financial aid for living expenses, childcare, housing costs, food and groceries, family support, and other expenses deemed appropriate with aid increasing based on the number of dependents to minimize as much as possible any potential family disruption during the course of enrollment pursuing midwifery certification for all midwifery degrees;
(4) the creation of a fund to incentivize midwives to serve in historically marginalized communities including but not limited to, a stipend, reimbursements, and other financial aid for living expenses, moving expenses, childcare, housing costs, food and groceries, family support, and other expenses deemed appropriate with aid increasing based on dependents to minimize as much as possible any potential family disruption during the course of enrollment pursuing midwifery practice and apprenticeship in these historically underserved areas;
(5) information which provides that, in the case of a midwife who is not employed and does not have an offer of employment as a midwife at the completion of a midwifery training program who subsequently becomes employed by, or receives an offer of employment from, a licensed long term care facility within 12 months of completing a midwife training and competency evaluation program, the long-term care facility is required to provide for the reimbursement of reasonable costs incurred in completing the midwife competency evaluation on a pro rata basis during the period in which the individual is employed as a midwife, which costs include, but are not limited to, fees for textbooks and other required course materials;
(6) information on State regulations concerning repayment of midwifery training in the event of voluntary or involuntary termination of employment;
(7) the creation of a fund for insurance reimbursements for the cost of midwifery practice; and
(8) any other information deemed relevant by the Commissioner of Health in collaboration with the commissioner.
e. The commissioner shall develop and disseminate the following educational materials:
(1) instructions on how to become a certified midwife in this State;
(2) information on and links to midwife training programs that are accredited by the State;
(3) the benefits of becoming a midwife in New Jersey, and the benefits of using a midwife;
(4) the ability of midwives working in long-term care facilities to take a nurse aide competency evaluation without cost;
(5) the ability of midwives to enter into their own practices and take on CPM and other certified midwife apprentices;
(6) information on the application process for reimbursement of midwife training course costs as provided in this act, and
(7) the history of the racial disparities in the midwifery field, its implication on existing maternal health outcomes, and the need for targeted reinvestments in historically marginalized and underrepresented communities.
f. All information collected and developed pursuant to this section shall be accessible to the public on the Internet website of both the Department of Health and Department of Labor and Workforce Development, on a page that is specifically dedicated to information related to midwives.
g. The commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt regulations to effectuate the purposes of this act.
5. a. There is established in the General Fund the "Targeted Workforce Development Program for Midwifery Training Fund" as a nonlapsing, revolving fund in the Department of Labor and Workforce Development for the purpose of providing educational and training grants to midwives, increasing the engagement of midwives in underserved communities, and incentivizing midwives and employers of midwives to maintain operations in historically marginalized communities.
b. The fund shall be established with an initial allocation from the General Fund pursuant to section 6 of this act and shall include:
(1) monies dedicated to incentivizing midwives, both in private and public practice, to work in historically marginalized communities;
(2) for employers of midwives, $30,000 as an annual subsidy for the training, retention, and salary of each one of the midwives employed in the employer's practice;
(3) for the midwives employed in their own practice, an annual payment of $50,000 to serve as a subsidy for the practice of midwifery, including but not limited to, assisting midwives to go into business for themselves in historically underserved communities;
(4) financial assistance for education and training costs, including but not limited to, costs of tuition, room and boarding, and supplies;
(5) financial assistance for nontraditional students enrolled in midwife educational and training program and practicing midwives, for various family support needs, which initial cost per midwife or midwifery student shall be $150,000; and
(6) monies for the administration, staffing, marketing, and educational outreach of the "Targeted Workforce Development Program for Midwifery Training Fund" to effectuate the purposes of this act.
c. The amounts provided in subsection b. of this section shall be adjusted annually by any change in the consumer price index for all urban wage earners and clerical workers (CPI-W) as calculated by the federal government.
d. The commissioner shall deposit all funds collected pursuant to this act into the fund. Monies credited to the fund may be invested in the same manner as assets of the General Fund, and any investment earnings on the fund shall accrue to the fund and shall be available subject to the same terms and conditions as other monies in the fund.
e. Regarding appropriations for the "Targeted Workforce Development Program for Midwifery Training" for any subsequent calendar year, the department shall, not later than August 31 of the preceding calendar year, calculate anticipated expenses for the program and submit to the Joint Budget Oversight Committee the proposed budget necessary to continue the program, accompanied by a report disclosing the methodology and all information used to calculate the anticipated expenses. The Joint Budget Oversight Committee shall review the report and the underlying methodology and approve or disapprove the proposed budget within 20 business days after receipt of the proposed budget and provide an alternate budget in the case of disapproval. The department shall, not later than September 30 of the preceding calendar year, finalize the proposed budget upon approval of the committee or finalize the alternative budget upon being provided by the committee. Once finalized, the proposed budget shall immediately be made public, including by posting in a prominent place on the department's website.
The department's report to the committee accompanying the proposed budget shall include information on all factors used in the calculations to determine the budget, including the anticipated level of administrative spending based on the previous year's spending adjusted for any increased costs such as salary increases, plus any increases in cost due to additions of new staffing, software, or equipment necessary to effectuate the purposes of this act.
The fund shall be established with an initial allocation from the General Fund of $12,000,000 and shall include:
(1) monies dedicated to incentivizing midwives, both in private and public practice, to work in historically marginalized communities;
(2) for employers of midwives, $30,000 as an annual subsidy for the training, retention, and salary of each one of the midwives employed in the employer's practice;
(3) for the midwives employed in their own practice, an annual payment of $50,000 to serve as a subsidy for the practice of midwifery, including but not limited to, assisting midwives to go into business for themselves in historically underserved communities;
(4) financial assistance for education and training costs, including but not limited to, costs of tuition, room and boarding, and supplies;
(5) financial assistance for nontraditional students enrolled in midwife educational and training program and practicing midwives, for various family support needs, which initial cost per midwife or midwifery student shall be allocated at $150,000; and
(6) monies for the administration, staffing, marketing, and educational outreach of the "Targeted Workforce Development Program for Midwifery Training Fund" to effectuate the purposes of this act, which shall consist of an initial allocation of $1,000,000.
6. a. There is appropriated from the General Fund to the "Targeted Workforce Development Program for Midwifery Training Fund" the sum of $12,000,000. Of the initial funds, $1,000,000 for administration, staffing, marketing, and educational outreach.
b. The commissioner shall use funds not specifically allocated in the program to effectuate the purposes of this act, as appropriate.
7. This act shall take effect on the first day of the 10th month next following the date of enactment, except that section 6 shall take effect immediately and the commissioner shall take any anticipatory administrative action as may be necessary to effectuate the purposes of this act.
STATEMENT
This bill establishes the "Targeted Workforce Development Program for Midwifery Training." The purpose of the program is to address disparate outcomes in maternal and infant mortality rates between Black residents and other demographic groups, as well as to develop the midwife workforce in underserved communities.
The program will include the dissemination of educational materials and outreach to underserved communities on the benefits of using and becoming a midwife; subsidies for hiring midwives and being self-employed as a midwife in underrepresented communities; financial support for education and training to become a midwife; providing childcare and housing assistance to reduce financial burdens and make relocation more attractive; providing grants to community-led birthing hubs and wellness centers to hire and retain midwives from historically marginalized communities; creating mentorship networks to connect midwives from historically marginalized communities with established practitioners in underserved communities; and establishing community partnerships to build collaborations between medical schools, hospitals, and community-led birthing hubs and wellness centers to create pipelines for midwives representing historically marginalized communities.
New Jersey has one of the biggest disparities in the country in maternal mortality between Black women and white women. In its 2016-2018 review of maternal mortality, the New Jersey Department of Health found that the pregnancy-related maternal mortality rate for Black, non-Hispanic women was 39.2 deaths per 100,000 live births, which was 6.6 times higher than the rate for white, non-Hispanic women (5.9 per 100,000 live births).
The Network for Public Health Law cited data that, compared to white women, Black women more frequently reported: having their pain minimized or ignored; having still births; unfair treatment and disrespect by providers because of their race; no patient autonomy during pregnancy, labor, and delivery; and pressure to have a cesarean section. The disparate treatment and access to healthcare for Black women leads to disparate maternal health outcomes.
With respect to infant mortality, Black infants in New Jersey have a much higher infant mortality rate than white infants, specifically finding that Black infants are 3.5 times more likely to die before their first birthday than white infants.
The program's goals are to increase the number of midwives in the State in underserved communities, improving health outcomes for Black mothers and infants, increasing economic prosperity within those same communities. The profession of midwifery is well-paying, and midwives are much needed in the State to address healthcare worker shortages in the healthcare industry.
The bill appropriates funds from the General Fund to implement its provisions.
