Does Medicaid Cover Home Birth? 2026 State-by-State Guide

Yes for CNM services, conditionally for CPM and other non-nurse midwife credentials. Federal Medicaid law requires every state to cover services provided by a Certified Nurse-Midwife. ^[1] This requirement was added by the Omnibus Reconciliation Act of 1980 and expanded in 1993 to remove the original maternity-only limitation. ^[4] All 50 states and the District of Columbia comply.

Coverage of Certified Professional Midwives is different. The federal mandate doesn't reach CPMs because the law specifically names "nurse-midwife." States choose individually whether to recognize CPMs (or state-specific equivalents like Licensed Midwives, Direct-Entry Midwives, or Documented Midwives) as eligible Medicaid providers. NACPM tracked 14 states as of 2025: Alaska, Arizona, Colorado, Minnesota, Montana, New Hampshire, New Mexico, Oregon, South Carolina, Texas, Utah, Vermont, Washington, and Wisconsin. ^[2] Three significant recent expansions are in progress: New Jersey (NJ FamilyCare added CPM and CM coverage in 2024), ^[9] Massachusetts (the August 2024 Maternal Health Bill directed MassHealth to cover Certified Professional Midwives once state CPM licensure is established; as of late 2025, the licensure framework and MassHealth billing processes were still being developed), ^[10] and Colorado (the Medical Services Board finalized home birth coverage for CPMs, DEMs, and CMs effective August 14, 2025). ^[11]

A third question is often confused with the first two: does Medicaid cover home birth as a billable place of service? CNM services delivered at home are technically covered everywhere CNMs are licensed, but a small number of states explicitly exclude home birth from Medicaid even for CNMs. Alabama, Indiana, Maine, Nebraska, North Carolina, and Oklahoma all restrict CNM Medicaid billing to hospital and birth-center settings. Nebraska Statute 38-613 prohibits CNMs from attending home births; advocacy groups characterize this as making attendance a felony, while the statute itself authorizes license revocation as the documented penalty. ^[12] The National Academy for State Health Policy's 50-state analysis tracks these place-of-service rules. ^[3]

Three midwifery credentials matter for Medicaid eligibility, and they're paid differently.

Certified Nurse-Midwives (CNMs) are advanced practice registered nurses with a graduate degree in midwifery. They're licensed in all 50 states and reimbursed by Medicaid in all 50 states + DC under federal mandate. CNMs may attend hospital, birth center, or home births depending on state scope-of-practice law.

Certified Professional Midwives (CPMs) are credentialed by the North American Registry of Midwives. They specialize in out-of-hospital birth and are licensed in 37 states. Medicaid covers CPM services in 14 of those states. ^[2]

Licensed Midwives (LMs) is a state-specific credential, used in California, Florida, and a handful of other states. LM Medicaid coverage tracks closely with CPM coverage and varies by state.

Certified Midwives (CMs), a non-nurse credential offered by ACNM, exist in only a few states (New York, Maryland, Rhode Island, Delaware, Hawaii, Maine, Missouri). Medicaid coverage is rare and state-specific.

Once you separate "covers a credential" from "covers a place of service," Medicaid home birth coverage falls into five practical tiers.

Tier 1 - Full coverage with CPM expansion: 17+ states cover both CNMs and CPMs (or state-specific equivalents like LMs, DEMs, CMs) and reimburse home birth as a place of service. The 14-state NACPM list (Alaska, Arizona, Colorado, Minnesota, Montana, New Hampshire, New Mexico, Oregon, South Carolina, Texas, Utah, Vermont, Washington, Wisconsin) plus 2024-2025 expansions in New Jersey, ^[9] Massachusetts, ^[10] and Colorado's August 2025 rule. ^[11] These are the strongest profiles for a Medicaid-covered home birth.

Tier 2 - CNM coverage with home birth recognized: Most other states reimburse CNM services at home where state scope-of-practice rules permit. Families wanting home birth must find a CNM willing to attend; the constraint is provider supply, not policy.

Tier 3 - CNM payment-parity leaders: A subset of states pay at or near 100 percent of the physician rate. Connecticut (100 percent since 2021), DC (100 percent as of 2025), Louisiana (95 percent since August 2023), and Mississippi (SPA 22-0018 update). ^[2] Higher rates correlate with more midwives accepting Medicaid clients.

Tier 4 - Place-of-service exclusions: Six states reimburse midwifery but exclude home as a covered place of service: Alabama, Indiana, Maine, Nebraska, North Carolina, and Oklahoma. CNM-attended hospital and birth-center deliveries are covered, but home birth is not Medicaid-billable, even by an in-state CNM.

Tier 5 - Provider scarcity binds before coverage: A handful of states have technical Medicaid coverage but minimal practitioner supply. Kentucky has only two CNMs participating in Medicaid statewide; ^[2] Iowa has one Medicaid-billing CNM home birth practice; Hawaii does not allow direct CNM Medicaid billing. Coverage on paper exceeds practical access.

Five state policy changes since 2021 have meaningfully widened access. If you're researching coverage, the date of the source matters: NACPM's 14-state list reflects the pre-2024 baseline.

New Jersey (2024): NJ FamilyCare added Medicaid coverage for Certified Professional Midwives and Certified Midwives. ^[9] CPM Medicaid coverage was previously not established in NJ.

Massachusetts (August 2024): The Maternal Health Bill (Chapter 186 of the Acts of 2024, S.1992/H.4999) directed MassHealth to cover Certified Professional Midwives once state CPM licensure is established. ^[10] As of late 2025, the state CPM licensure framework and MassHealth CPM billing processes were still being developed by the Bay State Birth Coalition advocacy effort.

Colorado (April 2024 + August 2025): Colorado expanded planned home birth coverage in two stages. The April 2024 rule extended Health First Colorado to cover home birth attended by CPMs and CNMs. The August 14, 2025 Medical Services Board final rule established formal coverage for home birth attended by CPMs, Direct-Entry Midwives, and Certified Midwives. ^[11]

New York (February 2026): New York published updated Medicaid standards for licensed midwife home birth billing, clarifying eligible CPT codes and place-of-service rules for CNMs and Licensed Midwives in standalone practice.

Kansas (2024-2025): KanCare modernized maternal health coverage with rate increases for CNMs and the addition of doula services across all three KanCare MCOs. KanCare is also actively assessing CPM Medicaid coverage expansion.

Connecticut (2021): Connecticut Medicaid moved CNM reimbursement to 100 percent of physician parity in 2021 - one of the earliest payment-parity moves and a reference point for advocacy in other states. ^[2]

Reimbursement rates are the second barrier most home birth families run into. Even when a state covers a credential, the dollar amount paid is often well below the private-pay rate, and the gap shapes which midwives accept Medicaid.

The benchmark is CPT code 59400, the global maternity care fee covering prenatal visits, labor and delivery, and postpartum care. For 2026, NACPM tracks state Medicaid reimbursement at 50 to 100 percent of the physician rate, with about half of states at full parity. ^[3]

The private-pay range for an uncomplicated home birth runs $4,000 to $6,500 in most U.S. metros. Medicaid reimbursement, even at 100 percent of physician rates, often pays $1,500 to $4,000. The gap is what most midwives describe when they explain why they don't accept Medicaid clients in volume.

The structural reason is reimbursement parity. A midwife who can serve six private-pay clients per month at $5,000 each cannot replace that income by serving Medicaid clients at $2,200 each unless she takes on more clients than is safe or sustainable.

Four practical barriers compound the rate problem, and the state guides above document specific examples:

Administrative load: Medicaid billing requires provider enrollment in each state's MMIS, prior authorization for some services, and submission with specific CPT and ICD-10 codes. Many home birth midwives are solo practitioners without billing staff. Kentucky's barrier is illustrative: only two CNMs statewide currently participate in Medicaid for home birth. ^[2]

Hospital privilege requirements: Some state Medicaid programs require home birth midwives to have hospital admitting privileges or a written collaborative agreement with a physician. Louisiana CNMs face this barrier in rural parishes, where local hospitals are unwilling to extend privileges. Iowa has only one Medicaid-billing CNM home birth practice statewide for the same reason.

Place-of-service exclusions: Even where midwives are credentialed and willing, six states (AL, IN, ME, NE, NC, OK) exclude home birth as a billable place of service. ^[3] An Alabama CNM who'd attend a planned home birth can't bill Medicaid for it; the family pays out of pocket.

Legal status restrictions: Nebraska is the most extreme case: planned home birth attended by any licensed provider, including a CNM, is currently a felony. ^[12] Even where Medicaid would technically pay, the legal exposure makes home birth practice impossible for credentialed midwives.

Out-of-network risk: If a Medicaid client transfers to a hospital that's not in the Medicaid managed-care network, the family can be billed for the entire hospital stay. Midwives often decline Medicaid clients to avoid this risk.

The result, documented in a 2024 Robert Wood Johnson Foundation report, is that maternal-health access for Medicaid recipients is concentrated in hospitals even when families would prefer home or birth-center care. ^[5]

There's no single national directory of Medicaid-accepting midwives. State Medicaid programs publish provider directories that vary in quality, and many willing midwives aren't listed because of enrollment friction. The fastest path is to start with your state-specific guide and work outward from there.

If you're in one of the 36 states + DC where Medicaid covers CNM services but doesn't recognize CPMs (and most home birth midwives in your area are CPMs), you have three realistic options.

Option 1: Find a CNM who attends home births. CNMs who do out-of-hospital work exist in most states but are concentrated in metro areas. Medicaid covers their services everywhere CNMs practice. The trade-off is fewer CNMs are doing home birth than CPMs in most regions.

Option 2: Sliding-scale or partial coverage. Some midwifery practices accept Medicaid clients on a reduced-fee or partial-pay arrangement, where Medicaid covers the prenatal and postpartum components and the family pays out-of-pocket for the birth attendance. Ask early if this option is available.

Option 3: Use Medicaid for hospital backup. Plan a home birth with private-pay funds, but enroll in Medicaid so that if a hospital transfer happens during labor, hospital-based care is covered. This is a common arrangement in states where home birth itself is uncovered but transfer-related hospital care is fully covered.

Yes. If you have both Medicaid and private insurance (often called "dual coverage" or "Medicaid as secondary"), the private insurance pays first and Medicaid picks up what private insurance doesn't cover, up to the Medicaid allowable rate.

For home birth specifically, dual coverage works well because private insurance typically pays out-of-network reimbursement (50 to 80 percent of the billed amount) and Medicaid can cover the remainder. The midwife bills private insurance first, then submits a Medicaid claim for the residual. The family typically owes nothing.

If your private insurance excludes home birth entirely, Medicaid still covers the CNM service component as a primary payer. CPMs follow whatever Medicaid rule applies in your state.

Looking for a midwife in your state? Each state article covers licensing, costs by region, Medicaid coverage, transfer hospitals, and what to ask before hiring. Start with: California, Texas, New York, Florida, Pennsylvania, Oregon, Washington, Colorado, Michigan, Georgia, Massachusetts, North Carolina, Utah, Vermont, Ohio , or browse all 50 states.