Medicaid is a joint federal and state program providing health coverage to millions, including many pregnant individuals. Midwives are trained health professionals offering comprehensive, often low-intervention care during pregnancy, labor, and postpartum. Medicaid generally covers these services, but specific details—including which providers and settings are covered—depend heavily on individual state program rules. Navigating the options requires understanding differences in provider credentials and state-level policy.
Covered Midwifery Provider Credentials
Federal law mandates that all state Medicaid programs cover services provided by Certified Nurse-Midwives (CNMs). CNMs are registered nurses who have completed advanced, graduate-level education and passed a national certification exam. They are recognized as primary care providers under federal law and often practice within hospitals, clinics, or licensed birth centers.
Coverage for other types of midwives is not federally mandated and remains at the discretion of each state. These include Certified Midwives (CMs), who possess similar graduate-level education but are not required to be registered nurses. They also include Certified Professional Midwives (CPMs), who are direct-entry midwives traditionally focused on out-of-hospital birth settings.
Because CMs and CPMs are not included in the federal mandate, state licensing laws determine whether their services are reimbursed by Medicaid. Currently, only a minority of states voluntarily provide Medicaid coverage for these non-nurse midwife credentials. This creates significant gaps in access, especially for individuals seeking care from community-based or home birth-focused midwives.
State Policy and Birth Setting Coverage
Coverage for midwifery services is not uniform, as state Medicaid agencies determine their own reimbursement rates and the specific settings they will cover. The state’s decision to cover non-CNM providers, such as CMs or CPMs, is one major variable that influences choice. Low reimbursement rates, sometimes set at a fraction of what physicians receive, can discourage midwives from accepting Medicaid patients.
For birth settings, coverage is generally straightforward for hospital births, where CNMs routinely practice. Licensed freestanding birth centers, which are often staffed by midwives, are also a mandatory Medicaid benefit under federal law. Despite this mandate, birth centers frequently face barriers, including low facility reimbursement rates, which can limit their capacity to serve Medicaid beneficiaries.
Coverage for home births is the most variable element of state Medicaid policy regarding maternity care. More than half of states have policies that allow for Medicaid reimbursement of planned home births. However, coverage is not universal and often comes with specific limitations based on the state’s licensing of the provider.
A state may only cover a home birth if it is attended by a CNM, while other states may cover home births attended by a CPM or Licensed Midwife (LM) if that credential is recognized. Furthermore, states often impose requirements such as prior authorization for a planned home birth. This ensures the pregnancy is low-risk and medically appropriate for that setting.
Navigating Medicaid Midwifery Access
Individuals enrolled in Medicaid must first verify their current coverage status and benefit details by contacting their state Medicaid agency or Managed Care Organization (MCO). Coverage is typically comprehensive throughout the entire maternity cycle, including prenatal visits, labor and delivery, and the standard 60-day postpartum period. Understanding the specific state plan is necessary because MCOs, which manage care for many recipients, may have different provider networks and rules than the state’s fee-for-service program.
Finding an in-network midwife involves consulting the state’s official provider directory or the MCO’s list of participating practitioners. A midwife must be actively enrolled as a Medicaid provider in that state to receive reimbursement for services rendered. Even if a certain type of midwife is licensed in the state, they must still complete the enrollment process to accept Medicaid patients.
For specific services or out-of-hospital settings, a recipient may encounter prior authorization requirements. Prior authorization is a process where the provider must request approval from the Medicaid agency or MCO before delivering the service. This step is often mandated for planned home births to confirm that the pregnant individual meets established low-risk criteria. The provider usually handles the submission of this request.