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

Yes for CNM services, conditionally for CPM services. 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 as eligible Medicaid providers, and as of 2025 only 14 states do so: Alaska, Arizona, Colorado, Minnesota, Montana, New Hampshire, New Mexico, Oregon, South Carolina, Texas, Utah, Vermont, Washington, and Wisconsin. ^[2]

There's a third question that's 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, but some state Medicaid programs require care to be delivered in a hospital or birth center for full reimbursement. The National Academy for State Health Policy's 50-state analysis notes that states often require non-nurse midwives to deliver in the home or a freestanding birth center as a billable POS. ^[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.

Coverage falls into three tiers based on which midwife credentials a state's Medicaid program reimburses and whether home birth as a place of service is recognized.

Full coverage (CNM + CPM/LM, home birth recognized): These 14 states reimburse the broadest range of midwives in the broadest range of settings. ^[2] This is the strongest profile for a family planning Medicaid-covered home birth.

CNM-only coverage: The remaining 36 states + DC reimburse CNM services everywhere CNMs practice, including at home, but CPMs are not eligible Medicaid providers. Families on Medicaid who want a CPM home birth pay out of pocket or self-pay sliding scale.

Home birth POS restrictions: Some states reimburse midwifery services but require care be delivered in a hospital or birth center setting for full reimbursement. The exact list of states with these restrictions changes frequently as state Medicaid manuals are updated, and is not comprehensively tracked in any single public source. The most reliable approach is to call your state Medicaid program directly.

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.

Three practical barriers compound the rate problem:

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.

Backup provider requirements: Some state Medicaid programs require home birth midwives to have a written collaborative agreement with a physician or hospital. In communities where local OBs are unwilling to sign these agreements, midwives can't enroll as Medicaid providers even when they want to.

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 the practical reality is that many willing midwives aren't listed in the official directory because of enrollment friction. The fastest path is the four-step workflow below.

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.