Brokers advising health professionals face an unusual PI problem from January: an insurer, a mandatory coverage requirement, and a workforce that may be about to contract.
Medical Insurance Group Australia (MIGA), a South Australia-based indemnity insurer that has covered healthcare professionals for more than 120 years, is the sole provider of private midwife professional indemnity insurance in Australia. From January 1, 2027, all privately practising midwives (PPMs) must hold MIGA’s product to continue working. There is no competing capacity.
The transitional exemption under Section 284 of the Health Practitioner Regulation National Law, in place since 2010, has allowed PPMs to attend homebirths without holding professional indemnity insurance (PII) for intrapartum care. It will end on December 31, 2026, and will not be extended, according to the Nursing and Midwifery Board of Australia (NMBA).
The Australian College of Midwives (ACM) warns up to a third of the approximately 500 midwives in private practice could exit the profession by January.
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The Commonwealth expanded its Midwife Professional Indemnity Scheme (MPIS) to cover out-of-hospital intrapartum care after no insurer was willing to offer it on the open market. A preliminary digest of the amending legislation published by the Australian Parliament noted that insurers cited difficulty quantifying risk, a lack of claims data, and the small number of services provided.
Since July 1, 2025, the MPIS has covered 100% of eligible claims for out-of-hospital intrapartum care, including homebirths and Birthing on Country services, the Department of Health and Aged Care confirmed. The scheme reimburses insurers between 80% and 100% of eligible claim costs depending on the claim amount.
As at September 2023, 380 midwives were insured under the existing MPIS, and 104 PPMs were providing private homebirth services, according to the same parliamentary document.
Eligibility for MIGA’s product is limited to “endorsed” midwives holding a scheduled medicines endorsement, which requires additional study and 5,000 hours of clinical practice accrued over the previous six years.
NMBA registration data for 2024-25 shows 1,507 midwives hold an endorsement out of 34,347 registered midwives nationally.
Kelley Lennon, chief midwife at the ACM in Canberra, told ABC News the endorsement pathway enabled midwives to prescribe medication and order tests but was not necessary for a second practitioner assisting a birth.
“The concern is that if women aren’t able to access a midwife, they may consider to birth without a registered health practitioner, which we know of as a freebirth,” Lennon said.
She said she had met with the federal government to advocate for a more accessible insurance product.
Australian regulations require a second practitioner at each homebirth. Ruth Davison, an endorsed midwife practising privately in the Mackay region of North Queensland since 2021, said only one other insured midwife operated in her area, and that practitioner was frequently unavailable.
“I can [currently] have a registered midwife, I can have a registered nurse, a doctor, or a paramedic. But come the first [of January], I’m not going to be able to have that,” Davison told ABC News.
Jessica McGair, a midwife who splits her time between Mackay Base Hospital and assisting private homebirths in the region, said the endorsement timeline was a barrier for part-time practitioners.
“I only work part-time, and that would look like about six years before I would even be eligible to be endorsed, plus also further study as well,” McGair said.
Australian Institute of Health and Welfare data shows homebirths more than doubled between 2019 and 2023, rising from 923 (0.3% of all births) to 2,081 (0.7%).
The trend comes as the broader Australian PI market has seen expanded capacity and flat-to-reduced pricing for in-appetite professions through the first half of 2026. But the midwife segment sits outside that dynamic: with a single government-backed provider and no competing capacity, standard market forces do not apply.
Under the Australian Health Practitioner Regulation Agency’s (AHPRA) registration standards, all 15 regulated health professions must hold PII as a condition of registration. The Section 284 exemption allowed midwives providing homebirth intrapartum care to practise without it.
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The NMBA opened a public consultation in April 2026 on proposed changes to the endorsement registration standard, including the removal of the 5,000-hour clinical practice requirement. Feedback closed in June 2026, and the board has not yet announced the outcome.
The NMBA said the insurance changes were not about limiting homebirths but about protecting the public “from financial and safety risks resulting from a negligent act, error, or omission in a practitioner’s conduct.”
If the 5,000-hour requirement is dropped, the number of midwives eligible for MIGA’s product could increase, potentially expanding the insurable pool. Until then, brokers advising allied health professionals on their professional indemnity obligations face a market with one provider, a government backstop covering 100% of claims, and a workforce that may be about to shrink.
