Does Health First Colorado Cover Home Birth? 2026 Coverage After Two Major Rule Expansions in 2024 and 2025
Yes. Health First Colorado (Colorado Medicaid) covers home birth attended by Certified Nurse-Midwives, Certified Professional Midwives, Direct-Entry Midwives, and Certified Midwives. [1] Two major rule expansions made this happen: April 2024 added CPMs/DEMs as approved Medicaid maternal health providers, and August 2025 finalized the rule allowing them to attend home birth services specifically. [1,2] Colorado now has one of the broader midwifery Medicaid coverage profiles in the country.
Colorado moved decisively in 2024 and 2025 to expand Medicaid coverage of midwifery care. The Colorado Department of Health Care Policy and Financing (HCPF) added Direct-Entry Midwives and Certified Professional Midwives as approved maternal health providers effective April 1, 2024, [1] and the Colorado Medical Services Board finalized the rule making home birth a covered place of service for those credentials effective August 14, 2025. [2] Home birth provider fees are paid at the same rate as hospital-based providers for low-risk births. [3] If you're on Health First Colorado, the legal coverage is recently strong and access is genuinely expanding.
On this page
Sources cited (5)
- Colorado HCPF Reproductive Health Coverage
- CO MSB Rule 24-11-04-A (Aug 2025)
- Colorado HCPF Stakeholder Q&A
- Social Security Act § 1905(a)(17)
- Colorado DPO DEM Page
Does Health First Colorado cover home birth?
Yes. Health First Colorado covers home birth attended by any of four credentialed midwifery provider types: Certified Nurse-Midwives, Certified Professional Midwives, Direct-Entry Midwives, and Certified Midwives. [1,2] The structure was put in place in two steps:
April 1, 2024: HCPF added Direct-Entry Midwives (DEMs) and Certified Professional Midwives (CPMs) as approved maternal health providers under Health First Colorado. [1] DEMs and CPMs were authorized to provide labor, delivery, and postpartum care for eligible Medicaid members.
August 14, 2025: The Colorado Medical Services Board finalized the rule allowing CPMs/DEMs and Certified Midwives (CMs) as approved provider types specifically for home birth services. [2] The 2025 expansion also clarified that CPMs/DEMs are excluded from direct supervision requirements while administering home birth services.
Providers are required to carry malpractice insurance that specifically covers home births. [2]
Which midwife credentials does Health First Colorado cover?
Colorado Medicaid recognizes four midwifery credentials, all eligible for Medicaid billing.
Certified Nurse-Midwives (CNMs) are licensed by the Colorado State Board of Nursing as Advanced Practice Registered Nurses. CNM services are a federal Medicaid mandatory benefit. [4]
Direct-Entry Midwives (DEMs) are credentialed by the Colorado Division of Professions and Occupations (DPO). The DEM credential is Colorado's pathway for non-nurse direct-entry midwives. [5] Colorado DEMs hold the NARM CPM credential plus state-specific licensure.
Certified Professional Midwives (CPMs) holding the NARM credential are eligible Medicaid providers under the 2024 HCPF rule, and the home birth setting was added in the 2025 Medical Services Board rule. [1,2]
Certified Midwives (CMs) were added to the home birth provider type list under the August 2025 rule. [2]
All four must be enrolled with HCPF as Medicaid providers and carry malpractice insurance covering home births. [2]
| CREDENTIAL | CO MEDICAID COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [4] | Hospital, birth center, home |
| Direct-Entry Midwife (DEM) | Yes (since April 2024) [1] | Birth center or home |
| Certified Professional Midwife (CPM) | Yes (since April 2024) [1] | Birth center or home |
| Certified Midwife (CM) | Yes (since August 2025) [2] | Birth center or home |
How does Health First Colorado reimburse home birth midwives?
Colorado Medicaid reimburses home birth at meaningful rates. HCPF pays for birth services in two ways: provider fees and facility fees. Currently, home birth provider fees are the same as hospital-based providers for low-risk births. [3]
The facility fee piece is where Colorado is still working out the structure. HCPF doesn't currently have a home birth facility reimbursement rate but is engaging the community and other states with home birth facility reimbursement methodologies through the Medicaid Provider Rate Review Advisory Committee (MPRRAC). [3] In practice this means CPM, DEM, and CM home birth attendance is paid for via professional fees, and any additional facility-level reimbursement may be added by HCPF in coming policy updates.
Health First Colorado is delivered through Regional Accountable Entities (RAEs) for managed care. Each RAE administers Medicaid for its assigned region within HCPF guidelines.
"Colorado moved from a CNM-only Medicaid program to a four-credential program in 18 months. The 2024 expansion was the policy shift; the 2025 rule was the operational follow-through.
On Colorado's recent Medicaid expansion
How do you find a Medicaid-accepting midwife in Colorado?
Colorado has a robust home birth midwifery community concentrated in the Front Range (Denver, Boulder, Fort Collins, Colorado Springs) and growing in mountain communities. Because the Medicaid expansion is recent, some midwives are still onboarding to HCPF as enrolled providers.
Identify your RAE / Health First Colorado plan
Your enrollment lists your Regional Accountable Entity. RAEs administer managed care for Health First Colorado in their assigned region.
Search the HCPF provider directory
HCPF maintains a provider directory at hcpf.colorado.gov. Search for "midwife" or "certified nurse-midwife" in your county. Note which providers are listed under each credential.
Cross-reference with the Colorado Midwives Association
The Colorado Midwives Association (coloradomidwives.org) maintains a directory of practicing CPMs and DEMs. Cross-reference with HCPF and your RAE's network.
Confirm 2026 Medicaid enrollment by phone
Because the home birth expansion is so recent, ask each practice: "Are you currently enrolled with Health First Colorado as a home birth provider for 2026?" Some midwives are still completing enrollment paperwork.
What's still unsettled in Colorado's home birth Medicaid coverage?
The August 2025 rule clarified the legal framework but left two operational questions in motion:
Facility fee structure. HCPF has noted it doesn't yet have a home birth facility reimbursement rate. [3] The Medicaid Provider Rate Review Advisory Committee (MPRRAC) is engaging the community on methodology. Until that's settled, midwives bill the professional fee but cannot bill a facility component.
RAE-level network adequacy. Because the rule is so new, some Regional Accountable Entities haven't yet contracted with enough CPMs/DEMs to meet network adequacy standards across all regions. Network adequacy grievances are an option if your RAE has no in-network home birth midwives within reasonable distance.
Malpractice insurance availability. Providers must carry malpractice insurance that specifically covers home births. [2] The Colorado midwifery community has been working through availability of this coverage; some practitioners report difficulty finding it. Watch for community updates on this.
For a full guide to home birth midwives in Colorado, including licensing, costs by region, and what to ask before hiring, see our Colorado home birth midwife guide.
Bottom line: Health First Colorado made a major shift to broader midwifery Medicaid coverage in 2024-2025. CPMs, DEMs, CMs, and CNMs are all eligible to attend Medicaid-covered home birth. [1,2] Provider fees match hospital-based rates for low-risk births. [3] The expansion is recent enough that midwives are still onboarding to Medicaid panels, which gives 2026 families a real opportunity. Use the Colorado Midwives Association directory plus your RAE's network listing, confirm enrollment by phone, and watch HCPF for the upcoming facility-fee structure decision.
- Colorado Department of Health Care Policy and Financing. Reproductive, Perinatal, and Sexual Health. View source
- Colorado Medical Services Board. Rule 24-11-04-A: Home Birth Provider Types. Effective August 14, 2025. View source
- Colorado Department of Health Care Policy and Financing. Home Birth Stakeholder Engagement Questions and Answers. View source
- Social Security Act § 1905(a)(17), 42 U.S.C. § 1396d(a)(17). Mandatory Medicaid coverage of nurse-midwife services. View source
- Colorado Division of Professions and Occupations. Direct-Entry Midwifery. View source
▶ How we research and review this content Editorial standards
Every guide on Home Birth Partners is researched against primary sources (federal regulations, peer-reviewed clinical literature, and state-level licensing boards) and reviewed by a credentialed midwife before publication.
We update articles when source data changes, when state laws are revised, or at minimum every 12 months. The "Last reviewed" date in the byline reflects the most recent review.
If you spot an error or have a primary source we should add, email [email protected].