A licensed birth center is a facility that holds an operating certificate from the New York State Department of Health under Article 28 of the Public Health Law. An unlicensed one does not. That single difference determines whether the state has reviewed the building, the staffing pattern, the emergency equipment, the criteria used to decide who can safely give birth there, and whether a written hospital transfer agreement exists.
What it does not tell you is whether the midwives are qualified. In New York, midwives are licensed separately by the State Education Department, and a licensed midwife can practice lawfully in settings that are not licensed facilities. So when you compare options, you are checking two different things: the credentials of the people caring for you, and the regulatory status of the place you plan to give birth.
Quick Answer: What Is the Difference?
- Licensed birth center: Holds an Article 28 operating certificate from the New York State Department of Health. Must meet written standards for staffing, equipment, eligibility screening, medical records, newborn screening, and hospital transfer, and is inspected by the state.
- Unlicensed facility: Operates without that certificate. No state review of the building, staffing pattern, emergency equipment, or transfer plan, and no state facility complaint process.
- The midwives are a separate question: Midwives in New York are licensed individually by the State Education Department. A licensed midwife can practice lawfully in settings that are not licensed facilities.
Both settings may be staffed by licensed midwives. The difference is whether the facility itself is regulated, which also affects whether insurance or Medicaid will cover a facility fee.
What "licensed" actually means for a birth center in New York
New York does not issue one generic birth center license. Under Article 28, a freestanding center falls into one of two regulated categories, and they are not identical. For more background on how these facilities were developed in the region, see this overview of an NYS DOH-approved birth center collaboration serving Brooklyn and the Five Towns.
Birth center (10 NYCRR Part 754)
This is a diagnostic and treatment center certified to provide birth services to patients with uncomplicated pregnancies who need a stay of less than 24 hours after birth. The attending provider at the birth may be a physician or a licensed midwife. State rules define who meets those criteria, what must be in the medical record, and what postpartum and newborn care must be provided before discharge.
Midwifery birth center (10 NYCRR Part 795)
This category was created specifically for centers where care is provided principally by midwives. The attending provider at the birth must be a licensed midwife, licensed under Article 140 of the Education Law. The regulatory language describes a home-like setting and a view of pregnancy and birth as a normal physiological process supported with limited technological intervention.
What the license requires in practice
Certification is not a one-time formality. A licensed center has to demonstrate and maintain things like:
- Written, standardized criteria for determining who is eligible to give birth there, applied during pregnancy, labor, and after birth
- A defined arrangement for transferring a patient or newborn to a hospital, including hospital cooperation requirements written into state regulation
- Staff trained in newborn resuscitation according to Neonatal Resuscitation Program guidelines
- Newborn screening, eye prophylaxis, and other required newborn care under state public health rules
- Medical record standards, including cross-referenced parent and newborn records
- Physical plant standards for birthing rooms, exam rooms, and consultation space
Why the picture looked so confusing until recently
For years, New York's licensing requirements were written around much larger facilities, and midwife-led centers struggled to complete an application at all. Legislation signed at the end of 2021 streamlined the process for midwifery birth centers seeking an Article 28 operating certificate and aligned state requirements more closely with national accrediting standards. If you have read older articles claiming New York does not license midwife-led birth centers, that information is out of date.
What "unlicensed" usually means
This is where families get the most conflicting information, partly because the word covers several different situations.
1. A midwifery practice that attends home births
Some practices provide prenatal and postpartum care in a professional office and attend births in clients' homes. The clinician is fully licensed. The office is not a birth facility and does not need a facility license, because no births happen there. This is legal, regulated care, and it is not the same thing as an unlicensed birth center.
2. A facility marketing itself as a birth center without a certificate
The term "birth center" is used loosely in marketing. A space with birthing suites, a tub, and midwives on staff can look identical to a licensed center from the parking lot. Without an operating certificate, no state agency has reviewed that building's emergency equipment, staffing plan, or transfer arrangements.
3. A center still working through the approval process
Licensure involves architectural review, a certificate of need application, and inspection. A center may be genuinely in process and not yet certified. That is a reasonable thing for a center to tell you plainly, and a reasonable thing for you to ask about.
None of this means an unlicensed setting is unsafe or that the people working there are unqualified. It means the accountability structure is different, and you should know which one you are choosing.
Licensed vs. unlicensed: side-by-side
| What you are comparing | Licensed (Article 28) | Unlicensed facility |
|---|---|---|
| State oversight | Operating certificate, Department of Health inspection and survey | No state facility inspection |
| Eligibility criteria | Standardized written criteria required by regulation | Set internally by the practice |
| Hospital transfer | Formal transfer arrangement required; hospitals have corresponding obligations under state rules | May be informal, or based on the individual midwife's hospital relationships |
| Emergency preparedness | Equipment, drugs, and newborn resuscitation training specified in regulation | Varies by practice |
| Newborn screening and records | Required under state public health regulations | Varies; usually handled by the attending midwife |
| Insurance and Medicaid | Facility can bill a facility fee; Article 28 status is generally required for Medicaid participation | Frequently self-pay or out-of-network provider billing only |
| If you have a complaint | Department of Health facility complaint process, plus professional licensing boards | Professional licensing board for the individual clinician only |
Not sure what questions to ask when you visit a center? Come see ours in person. A tour of our Hewlett birth center is a good place to ask about facility standards, staffing, and transfer planning before you commit to anything.
Is accreditation the same as licensure?
No, and this distinction trips up a lot of families. Licensure is a legal requirement issued by the state. Accreditation is a voluntary review by a national organization.
The Commission for the Accreditation of Birth Centers has accredited freestanding birth centers since 1985 and is the only national body focused exclusively on birth centers. Its review looks at clinical practice, outcomes, records, staffing, and the physical facility against a detailed set of standards. Some states now reference accreditation directly in their licensing process, and New York's 2021 legislation moved in that direction for midwifery birth centers. Many insurers and Medicaid programs also look for it.
A center can hold one, both, or neither. Accreditation status can be checked independently through the Commission's public verification site.
Why the distinction matters for your actual care
Transfer planning
Most transfers from a birth center are not emergencies. They happen for slow labor progress, for pain relief the center cannot provide, or for a newborn who needs a longer period of observation. What matters is whether the plan is written down, whether the receiving hospital knows about it, and how long the drive takes. Licensure forces those answers to exist on paper.
Coverage and cost
Birth center care typically involves two kinds of charges: the professional fee for the midwifery care, and the facility fee for the use of the center. Licensed facilities can bill that facility fee, and Article 28 status is generally what makes Medicaid participation possible. If a center is unlicensed, ask specifically how the facility portion is billed and what your plan will actually reimburse. Our insurance page explains how we handle verification.
Continuity if your pregnancy changes
Not every pregnancy that starts in a birth center ends there. Plans change during labor for reasons that are usually routine rather than urgent. Whether that transition is smooth depends heavily on records, relationships, and preparation, all of which regulated facilities are required to document.
How to check whether a birth center is licensed in New York
- Ask the center directly. A licensed facility has an operating certificate and can tell you which category it holds and when it was issued. A straightforward answer is a good sign. Hesitation or vague language about being "state approved" is worth following up on.
- Check the state's facility listings. The Department of Health maintains public information on Article 28 facilities, including diagnostic and treatment centers and midwifery birth centers, through the NYS Health Profiles site and the state's open health facility data.
- Verify the midwives separately. Licensed midwives in New York are licensed by the State Education Department's Office of the Professions, which offers free online license verification. Certified nurse-midwives also hold national certification through the American Midwifery Certification Board.
- Check accreditation independently. The Commission for the Accreditation of Birth Centers publishes a searchable list of accredited centers rather than relying on a center's own claim.
- Ask about the transfer hospital by name. Not "we have a relationship with local hospitals," but which hospital, how far, and what the arrangement covers.
Questions worth asking on any birth center tour
- Are you licensed by the New York State Department of Health, and under which category?
- Are you accredited, and by whom?
- Which hospital do you transfer to, and how long is the drive?
- Who is the attending provider at birth, and who else is in the room?
- What are your criteria for deciding someone is no longer a candidate to birth here?
- What emergency equipment and medications do you keep on site?
- How often do transfers happen here, and for what reasons?
- What exactly does my insurance cover, and what will I owe?
Any center should be able to answer all eight without discomfort. If a question makes a provider defensive, that reaction is information too.
How we think about this at Birthing Center Long Island
Birth center care is designed for pregnancies that are healthy and expected to progress normally. Every midwife on our team holds New York State licensure and training in obstetrical emergencies and newborn resuscitation, and part of our job at a first visit is to review your history honestly and tell you if birth center care is not the right fit for your pregnancy. That conversation is more useful than any label.
We would give you the same advice we would give a friend touring somewhere else: ask about licensing, ask about transfer, ask about who will actually be with you in labor, and ask us those questions too. Being able to answer them clearly is part of what makes a center worth choosing. You can read about our midwifery team, or see how birth center care compares with other settings in our guide to birth options in Nassau County.
Have questions about birth center care?
Our midwifery team can walk you through how our care works, what a typical labor looks like here, and whether birth center care fits your pregnancy and health history. There is no pressure to decide anything at a first conversation.
Frequently Asked Questions
Are all birth centers in New York licensed?
No. New York licenses birth centers under Article 28 of the Public Health Law, but a facility can operate and market itself using the words "birth center" without holding an operating certificate. Licensure has to be verified rather than assumed.
Is an unlicensed birth center illegal?
Not necessarily, and the situations vary. A licensed midwife providing office-based prenatal care and attending home births is practicing lawfully without a facility license. Operating a facility that provides birth services without required state certification is a different matter. If you are unsure which situation applies, ask the center directly and check state facility listings.
What is an Article 28 birth center?
Article 28 of the New York Public Health Law governs licensed health care facilities. A birth center licensed under it is either a diagnostic and treatment center certified for birth services (Part 754) or a midwifery birth center (Part 795), where the attending provider at birth must be a licensed midwife.
Does licensure mean a birth center is safer?
Licensure is not a guarantee about any individual birth. It means the facility has been reviewed against state standards for staffing, equipment, eligibility screening, and hospital transfer, and that it is subject to ongoing oversight and a formal complaint process. Outcomes also depend on your pregnancy, your health history, and the clinicians caring for you.
Will insurance cover care at an unlicensed birth center?
Coverage varies by plan, but facility fees are generally tied to licensed facility status, and Medicaid participation typically requires Article 28 certification. Ask any center exactly what will be billed, by whom, and what your plan is expected to reimburse before you enroll in care.
How do I check whether my midwife is licensed?
Licensed midwives in New York are licensed by the State Education Department's Office of the Professions, which provides free online license verification. Certified nurse-midwives additionally hold national certification through the American Midwifery Certification Board.
What is CABC accreditation?
The Commission for the Accreditation of Birth Centers is a national body that reviews freestanding birth centers against detailed standards covering clinical practice, outcomes, staffing, and facilities. Accreditation is voluntary and separate from state licensure, though some states and insurers reference it.
Sources
Defines the regulatory categories for Article 28 birth centers and midwifery birth centers, including physical plant standards.
State regulations covering eligibility criteria, staffing, medical records, and postpartum and newborn care in licensed birth centers.
Defines a midwifery birth center as an Article 28 facility where the attending provider at birth must be a licensed midwife.
Announcement of the law streamlining Article 28 licensure for accredited midwifery birth centers.
Public listing families can use to check whether a facility holds state licensure.
National accrediting body for freestanding birth centers, with a public directory of accredited facilities.
Guidance on what to ask when evaluating a birth center, including licensure and accreditation.
Free online verification of individual midwifery licenses in New York.
This article was last reviewed in September 2026. Regulations and facility listings change; verify current licensing information directly with the New York State Department of Health.