Does Montana Medicaid Cover Home Birth? 2026 Coverage After House Bill 655 (2023) Expanded LDEM Eligibility
Yes. Montana Medicaid covers planned home birth for low-risk pregnancies attended by Certified Nurse-Midwives or Licensed Direct-Entry Midwives. [1] House Bill 655, passed in 2023, formally added home birth to the list of Medicaid-covered services in Montana. [2] The legal coverage is now solid, but practical access is limited by low Medicaid reimbursement rates that some Montana midwives describe as financially unsustainable. [2]
Montana made a major policy shift in 2023 when the state legislature passed House Bill 655, formally requiring Medicaid coverage for home births attended by qualified midwives. [2] The state's Medicaid program now reimburses Licensed Direct-Entry Midwives (LDEMs) and Certified Nurse-Midwives for planned home birth services for low-risk pregnancies. [1] The remaining barrier is reimbursement: Montana midwives report that the rate is low enough that not all practices can sustain Medicaid panels. This guide explains coverage, eligible providers, and the practical search.
On this page
Sources cited (5)
- MCA 53-6-101 (Montana Medicaid Authorization)
- Montana HB 655 (2023)
- Montana DLI Direct-Entry Midwife
- Mont. Admin. r. 37.86.1201
- Social Security Act § 1905(a)(17)
Does Montana Medicaid cover home birth?
Yes. Montana Medicaid covers planned home births for women with a low risk of adverse birth outcomes, as established by the appropriate licensing board, attended by Certified Nurse-Midwives or Direct-Entry Midwives licensed under Title 37, Chapter 27 of the Montana Code Annotated. [1] Coverage includes prenatal care, labor and delivery, and postpartum care.
The coverage was formalized in 2023 when the Montana Legislature passed House Bill 655. [2] Before that bill, home birth Medicaid coverage in Montana was variable. HB 655 added home birth as a required Medicaid-covered service and removed administrative barriers that had limited LDEM access to Montana Medicaid billing.
Which midwife credentials does Montana Medicaid cover?
Montana Medicaid recognizes two midwifery credentials.
Licensed Direct-Entry Midwives (LDEMs) are credentialed by the Montana Board of Alternative Health Care under Title 37, Chapter 27 of the Montana Code Annotated. [3] LDEMs typically hold the NARM Certified Professional Midwife credential plus Montana-specific licensure. They specialize in out-of-hospital birth and are Medicaid-eligible providers per Mont. Admin. r. 37.86.1201. [4]
Certified Nurse-Midwives (CNMs) are licensed by the Montana Board of Nursing as advanced practice registered nurses. CNM services are a federal Medicaid mandatory benefit under § 1905(a)(17). [5]
Unlicensed midwives cannot bill Montana Medicaid. The 2023 HB 655 expansion specifically addressed licensed providers; lay midwives operate outside the Medicaid framework.
| CREDENTIAL | MT MEDICAID COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [5] | Hospital, birth center, home |
| Licensed Direct-Entry Midwife (LDEM) | Yes (HB 655, 2023) [1,2] | Birth center or home |
| NARM CPM credential | Required for most LDEMs [3] | Bundled with state license |
How does Montana Medicaid reimburse home birth midwives?
Montana Medicaid maintains fee schedules and coversheets for Licensed Direct Entry Midwives. [4] Reimbursement is administered through fee-for-service Medicaid; Montana does not extensively use commercial managed care for Medicaid coverage.
The practical concern is rate. Montana Medicaid reimbursement for midwifery services is low enough that some midwives describe accepting Medicaid clients as financially unsustainable for an independent practice. [2] HB 655 addressed coverage but did not significantly raise rates. As a result, Medicaid coverage exists in policy but practical access varies depending on whether local midwives have closed their Medicaid panels or are still accepting clients.
"Montana solved the policy question with HB 655 but left the rate question unresolved. Coverage on paper is clear; coverage in practice depends on whether midwives can afford to take Medicaid clients.
On Montana's 2023 Medicaid expansion
How do you find a Medicaid-accepting midwife in Montana?
Montana's home birth midwifery community is small and concentrated in Missoula, Bozeman, Helena, and Billings. The Montana Midwifery Association is a useful starting point.
Confirm your Medicaid status
Montana Medicaid covers pregnancy services for eligible women. Your enrollment confirmation lists your status.
Search for licensed midwives by region
Home Birth Partners and the Montana Midwifery Association both maintain provider directories. Most LDEMs serve the western and central Montana corridor; eastern Montana has fewer options.
Confirm Medicaid panel status by phone
Because Medicaid rates can be financially unsustainable for solo practices, ask each midwife: "Are you currently accepting Medicaid clients in 2026?" Some midwives have closed their Medicaid panels even though they're enrolled.
Plan for travel if you're rural
If no licensed midwife serves your county, expect to travel to a metro area for prenatal care and delivery. Some rural Montana families relocate temporarily for the late pregnancy.
What if no licensed midwife in your area accepts Medicaid?
Three options exist if you can't find an LDEM with an open Medicaid panel:
Hospital-based CNM care. Montana Medicaid fully covers hospital-based CNM-attended birth. Several Montana hospitals have CNM-staffed maternity programs.
Birth center delivery. Freestanding birth centers in Missoula, Bozeman, and Helena staff CNMs and accept Medicaid. Birth-center delivery is fully covered with the same Medicaid eligibility as hospital delivery.
Pay out of pocket plus Medicaid for hospital backup. Some Montana families pay out of pocket for an LDEM's professional services while keeping Medicaid for prenatal labs, ultrasounds, and any hospital transfer. This bridges the rate gap when LDEMs have closed their Medicaid panels.
For a full guide to home birth midwives in Montana, including licensing, costs by region, and what to ask before hiring, see our Montana home birth midwife guide.
Bottom line: Montana Medicaid covers home birth attended by CNMs and Licensed Direct-Entry Midwives following HB 655's 2023 expansion. [1,2] The structural barrier is reimbursement, not coverage; some Montana midwives report rates so low that maintaining a Medicaid panel is financially difficult. Use the Montana Midwifery Association directory to find a Medicaid-accepting LDEM, confirm panel status by phone, and consider hospital-based CNM care or birth centers as fallbacks if no LDEM in your region has capacity.
- Montana Code Annotated. 53-6-101: Montana Medicaid program , authorization of services. View source
- Montana State Legislature. House Bill 655: An Act Requiring Medicaid Coverage of Certain Home Births. 2023. View source
- Montana Department of Labor and Industry, Board of Alternative Health Care. Direct-Entry Midwife. View source
- Montana Administrative Rules. 37.86.1201: Licensed Direct-Entry Midwife. View source
- Social Security Act § 1905(a)(17), 42 U.S.C. § 1396d(a)(17). Mandatory Medicaid coverage of nurse-midwife services. View source
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