Establishes "Targeted Midwifery Workforce Development Act"; appropriates $12 million.

S4228

SENATE, No. 4228

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED MAY 14, 2026

Sponsored by:

Senator� BRITNEE N. TIMBERLAKE

District 34 (Essex)

Senator� ANGELA V. MCKNIGHT

District 31 (Hudson)

Co-Sponsored by:

Senator Ruiz

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.