Does the Oregon Health Plan Cover Home Birth? 2026 OHP Coverage, Prior Authorization, and How to Find an LDM or CNM
Yes. The Oregon Health Plan (OHP) covers planned community birth, including home birth, for low-risk pregnancies attended by an OHA-enrolled Licensed Direct Entry Midwife (LDM), Certified Nurse-Midwife (CNM), Nurse Practitioner, or Naturopathic Physician. [1] Every pregnancy-related service for a planned community birth requires prior authorization from the Oregon Health Authority before billing, and the pregnancy must meet the low-risk criteria in the Health Evidence Review Commission's Guideline Note 153. [1] Coverage is real but conditional; confirm your provider's OHA enrollment early.
Oregon was one of the first states to bring Licensed Direct Entry Midwives into its Medicaid program, and the Oregon Health Plan still covers planned home birth as a recognized place of service for qualifying low-risk pregnancies. [1] The trade-off is a more rigorous prior authorization workflow than most states require, with documentation deadlines late in pregnancy and a final review after delivery. This guide explains how OHP covers home birth, who can attend, and the steps to set up coverage with an LDM or CNM.
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Sources cited (2)
- OHA, Planned Community Birth Guide
- Social Security Act § 1905(a)(17)
Does the Oregon Health Plan cover home birth?
Yes. OHP covers planned community births for low-risk pregnancies attended by an enrolled Licensed Direct Entry Midwife, Certified Nurse-Midwife, Nurse Practitioner, or Naturopathic Physician. [1] Coverage applies to home births and freestanding birth center births alike, with the same prior authorization workflow. Birthing centers receive a separate global facility payment, and home births include a packaged supply rate. [1]
OHP's policy is structured around evidence-based eligibility. The Health Evidence Review Commission's Prioritized List, through Guideline Note 153, sets the criteria for what qualifies as a low-risk pregnancy, and OHA's clinical reviewers check every prior authorization request against those criteria. [1] Approval is provisional: OHA keeps reviewing documentation as the pregnancy progresses and issues final authorization after delivery. [1]
Which midwife credentials does Oregon Medicaid cover?
Oregon recognizes four provider types for Medicaid-billable community birth attendance. [1]
Licensed Direct Entry Midwives (LDMs) are licensed through Oregon's Health Licensing Office and Board of Direct Entry Midwifery. The LDM credential is Oregon's pathway for non-nurse midwives, built on the NARM CPM credential plus state requirements. LDMs specialize in out-of-hospital birth and can bill OHP once enrolled with OHA. [1]
Certified Nurse-Midwives (CNMs) are licensed by the Oregon State Board of Nursing. CNM services are a federal Medicaid mandatory benefit under Section 1905(a)(17), [2] and Oregon CNMs can attend hospital, birth center, and home births.
Nurse Practitioners (NPs) with appropriate scope are also listed by OHA as community birth providers. [1]
Naturopathic Physicians (NDs) with natural childbirth training round out the list. [1] This is unusual nationally; most states do not recognize NDs for home birth Medicaid billing.
Whichever credential you choose, the provider must be enrolled with OHA and have written confirmation of enrollment before seeking prior authorization. Assistants acting as second birth attendants must be OHA-enrolled too. [1]
| CREDENTIAL | OHP COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [2] | Hospital, birth center, home |
| Licensed Direct Entry Midwife (LDM) | Yes if OHA-enrolled [1] | Birth center or home |
| Nurse Practitioner (NP) | Yes if OHA-enrolled [1] | Varies by practice |
| Naturopathic Physician (ND) | Yes if OHA-enrolled [1] | Home or birth center |
How does Oregon's prior authorization process work?
All pregnancy-related services for a planned community birth require prior authorization from OHA before billing. [1] The workflow is more involved than most states' but produces clear coverage when approved.
The provider (not the patient) submits the request to OHA with the appropriate delivery code and clinical documentation. OHA's Provider Clinical Support Unit reviews it against the low-risk criteria in HERC Guideline Note 153 and issues a provisional approval letter when the documentation supports community birth. [1] OHA's standard rule required the complete request by 34 weeks; the agency extended the documentation deadline to 38 weeks, 0 days gestation, and requests still missing documentation at that point are denied. [1] Ongoing chart notes continue through delivery, and OHA issues final authorization after the birth through concurrent review.
One detail worth knowing: once OHA provisionally approves community birth services, prenatal, delivery, and postpartum care are carved out of coordinated care organization (CCO) coverage and paid fee-for-service by OHA directly, even if a CCO manages the rest of your care. [1] Once approved, OHP covers risk assessments, antepartum visits, the delivery, postpartum care through 60 days past your due date, provider-administered medications, labor support before a hospital transfer, one enrolled birth assistant, and the newborn's initial evaluation. [1]
How do you find a Medicaid-accepting midwife in Oregon?
Oregon has a well-organized home birth midwifery community, anchored by the Oregon Midwifery Council and practices across the state. The fastest path is to confirm OHA enrollment directly with each midwife, then start care early enough for the paperwork to build.
Verify your OHP coverage
Confirm you're an active OHP member, whether through fee-for-service or a Coordinated Care Organization (CCO). Community birth services are paid fee-for-service by OHA either way once authorized, [1] so CCO network lists matter less here than for other care.
Ask each midwife about OHA enrollment
The provider must be enrolled with OHA and hold written enrollment confirmation before OHA will authorize or pay for community birth services. [1] Ask directly: "Are you enrolled with OHA as a Medicaid provider, and have you billed OHP for community births recently?"
Cross-reference with the Oregon Midwifery Council
The Oregon Midwifery Council and Home Birth Partners both maintain directories of practicing LDMs and CNMs. Check both for midwives in your county.
Start care early
OHA needs a complete prior authorization request with lab results, flow charts, and screening documentation, and denies incomplete requests after 38 weeks, 0 days. [1] Starting midwifery care in the first or second trimester gives your provider time to build the file.
What if your pregnancy doesn't meet the low-risk criteria?
If OHA's review finds your pregnancy doesn't meet the low-risk criteria in HERC Guideline Note 153, OHP won't authorize community birth. In that case, OHP fully covers hospital-based maternity care attended by a CNM or physician. Many Oregon CNMs practice in hospitals and birth centers; coverage doesn't disappear, only the place of service changes.
The criteria are evidence-based and cover factors like prior cesarean, gestational diabetes screening results, hypertensive disorders, multiples, and gestational age at delivery. [1] Reviewers also conduct concurrent review, so a pregnancy that becomes higher-risk late can lose authorization after provisional approval. [1] Discuss the criteria with your provider early so you know which factors could change your eligibility, and ask what the transfer plan looks like if risk status shifts mid-pregnancy.
For a full guide to home birth midwives in Oregon, including licensing, costs by region, and what to ask before hiring, see our Oregon home birth midwife guide.
Bottom line: Oregon's OHP provides genuine coverage for planned home birth attended by OHA-enrolled LDMs, CNMs, NPs, and Naturopathic Physicians, [1] with one of the most structured prior authorization processes in the country. The provider submits the request, complete documentation is due by 38 weeks, 0 days, approval stays provisional until after delivery, and authorized care is paid fee-for-service by OHA even for CCO members. [1] Start midwifery care early, confirm OHA enrollment before you commit, and use the Oregon Midwifery Council directory to find candidates.
- Oregon Health Authority, Health Systems Division. Planned Community Births (Out-of-Hospital Births): Prior Authorization and Billing Guide. September 2021. 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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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.
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