This is big.
I had absolutely no idea how California was going to continue expanding Medi-Cal under the ACA without finding a way to provide services for a huge increase in Medi-Cal-funded births. Medi-Cal now pays for roughly half of all births in California, a percentage sure to grow with the expansion of Medi-Cal. The tag line was always that the plan was to expand scope of practice for licensed mid-wives, now required to practice under the supervision of a physician in California.
And now it has happened. You can see Assembly Bill 1308, which takes effect in January of 2014, here: http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140AB1308. Independently licensed CNMs are restricted to lower risk births (singletons only, no major complications, etc.) but most births are lower risk births.
Most states consider midwives to be independent practitioners, so no triumphalism here. California, in fact, is bringing up the rear on this essential component of health care reform.