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 equivalents like Licensed Midwives and Licensed Direct-Entry Midwives) as eligible Medicaid providers. NASHP's 50-state analysis counted 18 states plus DC that allow Medicaid reimbursement of midwives without a nursing degree, as of 2023. ^[2] The list has grown since. New Jersey added CPM and CM coverage in 2024, ^[9] Colorado finalized home birth coverage for CPMs, DEMs, and CMs effective August 14, 2025, ^[11] Virginia moved licensed midwives to payment parity in July 2025, ^[16] and Illinois added Licensed Certified Professional Midwife coverage in July 2026. ^[17] Massachusetts enacted a 2024 law directing MassHealth to cover CPMs, but state CPM licensure had not opened as of mid-2026, so that coverage is not usable yet. ^[10]

A third question is often confused with the first two: does Medicaid pay for home birth as a place of service? The CNM provider mandate does not require states to pay for the home setting, and MACPAC's 2023 review of Medicaid access to midwives and birth centers describes wide state variation in out-of-hospital coverage. ^[15] Our state-by-state review found 11 states whose Medicaid programs exclude home birth outright or bar it in practice: Alabama, Delaware, Hawaii, Indiana, Iowa, Kansas, Maine, Michigan, Nebraska, North Carolina, and Oklahoma. Nine more publish no home-birth payment policy at all, which leaves coverage unconfirmed: Georgia, Mississippi, North Dakota, Ohio, Pennsylvania, Rhode Island, South Dakota, Tennessee, and Utah. Nebraska is the hardest stop: Neb. Rev. Stat. § 38-613 states that a CNM "shall not attend a home delivery," and no other midwife credential is licensed there. ^[12] The table below has the verdict for every state.

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 have a licensure path in 37 states plus DC. ^[14] Medicaid payment is the exception, not the rule: NASHP counted 18 states plus DC paying midwives without a nursing degree in 2023, ^[2] and a handful of states have joined since.

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 aligned with ACNM's education standards, are authorized in a small number of states. Medicaid coverage is rare and state-specific: DC, New Jersey, and Rhode Island enroll CMs as providers under current rules.

Once you separate "covers a credential" from "covers a place of service," Medicaid home birth coverage falls into four practical groups. Our review of all 51 jurisdictions, verified against state manuals in July 2026, sorts out this way.

Group 1 - Non-nurse midwife pathway: 21 states plus DC pay licensed non-nurse midwives (CPM, LM, LDM, DEM, or equivalent) for planned home birth: Alaska, Arizona, California, Colorado, Florida, Idaho, Illinois, Louisiana, Minnesota, Montana, New Hampshire, New Jersey, New Mexico, New York, Oregon, South Carolina, Vermont, Virginia, Washington, Wisconsin, Wyoming, and DC. These are the strongest profiles for a Medicaid-covered home birth, because most home birth midwives hold these credentials. Conditions still apply: Oregon requires prior authorization, South Carolina requires a Medicaid-enrolled back-up physician on file, and Virginia routes licensed midwife claims through fee-for-service.

Group 2 - CNM-only pathway: Nine states have a documented pathway only through a CNM or physician: Arkansas, Connecticut, Kentucky, Maryland, Massachusetts, Missouri, Nevada, Texas, and West Virginia. Texas is the narrowest: home delivery is reimbursed only with a physician or CNM attending plus written prior authorization requested in the third trimester, and its Licensed Midwives are paid for birth-center deliveries only. In several of these states the pathway exists on paper but very few CNMs attend home births, so provider supply is the binding constraint. Kentucky is the extreme case: the Kentucky Birth Coalition reports only two CNMs statewide attend home births within Medicaid plans.

Group 3 - Excluded or barred: Eleven states exclude home birth as a billable setting or bar it in practice: Alabama, Delaware, Hawaii, Indiana, Iowa, Kansas, Maine, Michigan, Nebraska, North Carolina, and Oklahoma. Hospital and birth-center midwifery care generally remains covered in these states; the home setting is not.

Group 4 - No published policy: Nine states publish no home-birth payment policy: Georgia, Mississippi, North Dakota, Ohio, Pennsylvania, Rhode Island, South Dakota, Tennessee, and Utah. A CNM-attended home birth may still be billable through a specific plan, but nothing guarantees it. Treat coverage as unconfirmed until your plan confirms it in writing.

Payment rates cut across all four groups. About half of states pay CNMs at 100 percent of the physician rate for the same service; ^[3] Connecticut and DC are at full parity, and Louisiana and New Jersey pay 95 percent. Higher rates correlate with more midwives accepting Medicaid clients.

Six state policy changes since 2024 have widened or clarified access. If you're researching coverage, the date of your source matters: national lists built before 2024 undercount.

New Jersey (2024): NJ FamilyCare added Medicaid coverage for Certified Professional Midwives and Certified Midwives, paying CNMs, CMs, and CPMs the same rates at 95 percent of the physician schedule. ^[9]

Massachusetts (August 2024): The Maternal Health Bill (Chapter 186 of the Acts of 2024) directed MassHealth to cover Certified Professional Midwife services once state CPM licensure is established. ^[10] As of mid-2026, licensure had not opened, so CPM coverage is not yet usable. CNM care is covered now.

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] Provider enrollment is still ramping.

Virginia (July 2025): DMAS implemented maternal health changes effective July 1, 2025, including payment parity for licensed midwives (CPMs) billed through fee-for-service, alongside CNM home birth coverage in Cardinal Care plans. ^[16]

Illinois (July 2026): Illinois Medicaid added coverage of Licensed Certified Professional Midwife services, including home and birth center births, on top of CNM billing in any setting. ^[17]

New York (2026): Updated Medicaid Perinatal Care Standards now apply to both fee-for-service and managed care plans, and Licensed Midwives bill directly for home birth without a written practice agreement. ^[18]

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. ^[3]

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. NASHP's 50-state analysis found about half of states reimburse CNMs at 100 percent of the rate paid to physicians for the same service, and 20 states pay 75 to 98 percent. ^[3] Non-nurse midwives are typically paid the same or slightly less where they're covered: Vermont pays Licensed Midwives 90 percent of the physician rate, and New Jersey pays CPMs the same 95 percent it pays CNMs. ^[9]

The private-pay range for an uncomplicated home birth runs $4,000 to $6,500 in most U.S. metros. Medicaid allowables usually land well below that, which helps explain why more than two-thirds of planned home births are self-paid even though Medicaid finances 41 percent of all U.S. births. [7,8] 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 at Medicaid allowables that often run at half that or less, 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 claims system, prior authorization in some states, and submission with specific CPT and ICD-10 codes. Many home birth midwives are solo practitioners without billing staff. Kentucky shows where this ends up: the Kentucky Birth Coalition reports only two CNMs statewide attend home births within Medicaid plans.

Physician back-up requirements: Some states condition midwife billing on a collaborative physician relationship. South Carolina pays licensed midwives for home birth only when a Medicaid-enrolled back-up physician is on file, and Texas requires a physician's low-risk statement plus written prior authorization before any home delivery is paid.

Place-of-service exclusions: Even where midwives are credentialed and willing, 11 states exclude home birth as a billable setting or bar it in practice: AL, DE, HI, IN, IA, KS, ME, MI, NE, NC, and OK. 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 hardest case. Neb. Rev. Stat. § 38-613 states that a CNM "shall not attend a home delivery," and Nebraska licenses no other midwife type, so no credentialed provider can legally offer a covered home birth there. ^[12]

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 29 states where Medicaid doesn't pay non-nurse midwives for home birth (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 can work well when the private plan pays an out-of-network share and Medicaid picks up remaining allowable amounts. The midwife bills private insurance first, then submits a Medicaid claim for the residual. Billing order rules differ by state and plan, so confirm the workflow with both payers before the birth rather than assuming a zero balance.

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.