Medicaid coverage for birthing centers is highly dependent on both location and the specific facility chosen. A birthing center is a facility designed for low-intervention, non-hospital births, typically led by midwives for individuals experiencing a low-risk pregnancy. These centers offer a home-like environment that contrasts with the medical setting of a hospital labor and delivery unit. While federal law mandates coverage for certain maternity services, the application of this rule to freestanding birthing centers varies significantly by state. Confirming coverage requires understanding state policy, facility requirements, and the specifics of your individual plan.
State-Specific Medicaid Coverage Rules
Coverage determination begins with the state where the recipient resides because Medicaid is administered by individual states within federal guidelines. Federal law mandates that states provide coverage for services delivered at licensed freestanding birthing centers. If a state licenses birthing centers, it must cover the facility fee for the delivery, making the service a mandatory benefit.
Forty-one states currently license freestanding birthing centers, obligating their Medicaid program to cover the services offered there. However, the state manages the actual implementation, including reimbursement rates and specific patient eligibility. This state-level control creates variations in how easily a birthing center can contract to become an approved provider.
Some states utilize a managed care model where a private Managed Care Organization (MCO) administers the Medicaid benefits. The MCO is responsible for contracting with providers and may not always include every licensed birthing center in their network. This means that even if the service is covered under state policy, the specific facility might be considered out-of-network by the plan. The state also determines the payment rate for the facility and the professional fees for the midwives.
Birthing Center Requirements for Medicaid Eligibility
A birthing center must meet specific criteria to enroll as a Medicaid provider. The facility must be licensed by the state as a freestanding birthing center. If a state does not license these facilities, the center cannot bill Medicaid for the facility fee.
Many states and Medicaid plans also look for accreditation, most commonly from the Commission for the Accreditation of Birth Centers (CABC). This accreditation signifies adherence to rigorous safety and operational standards, including written agreements for transferring patients to a nearby hospital in case of an emergency. Centers must also meet strict safety and staffing standards, such as having a medical director who is a physician or doctor of osteopathy.
The center must only accept low-risk pregnancies, as defined by accepted medical criteria. This is required because the facility is not equipped for high-risk deliveries. The center performs a risk screening to ensure the pregnant individual has an uncomplicated prenatal course and is expected to have a vaginal delivery. A center that does not meet all facility-specific requirements cannot enroll and be reimbursed by Medicaid.
Essential Steps for Confirming Your Coverage
Confirming coverage requires a proactive and detailed approach. The first step involves identifying the specific Medicaid plan you are enrolled in, particularly if your state uses a Managed Care Organization (MCO) model. The MCO is the entity that ultimately approves the network providers.
Once the plan is identified, contact the plan administrator directly and ask for a verification of benefits for a “freestanding birthing center facility fee” and “midwife professional services.” Use this exact terminology to avoid confusion with hospital-based services. Ask if the specific birthing center is currently an in-network provider under your plan.
If the center is in-network, request the plan to confirm the birthing center’s active provider identification number. To protect against billing issues later, document the following details:
Documentation Checklist
- The name of the representative.
- The date and confirmation number for the conversation.
- Written confirmation of coverage for the facility and attending midwife.
If a birthing center is not in-network, but the service is mandated by your state, ask the MCO about the process for obtaining an out-of-network authorization. The combination of state policy and plan-specific contract status determines your financial liability.
Covered Services and Remaining Costs
When a birthing center is an approved Medicaid provider, coverage includes the standard maternity care for a low-risk pregnancy. This covers the facility fee for labor and delivery, and the professional services of the attending midwife. Covered services include prenatal visits, labor management, the delivery itself, and immediate postpartum care, including two postnatal visits within six weeks.
Some out-of-pocket expenses may remain because not all services offered by the center are covered. Medicaid programs may not reimburse for certain nonclinical support services, such as specialized childbirth education classes, doula support, or specific supplies. Coverage for these support services is determined by the state and is not universally included in the benefit package.