Does Pennsylvania Medicaid Cover Home Birth?2026 HealthChoices Coverage, CNM Services, and How to Find a Medical Assistance Midwife
Pennsylvania Medical Assistance covers Certified Nurse-Midwife services in any practice setting, including home, as a federal mandatory benefit. [1] Certified Professional Midwives are not Medicaid-eligible providers in Pennsylvania. [2] Coverage is delivered through the HealthChoices managed care program for most Medicaid recipients in the state.
Pennsylvania has not joined the 14 states that recognize CPMs as Medicaid providers, so home birth coverage in Pennsylvania is essentially CNM-only. [2] But CNM coverage is real and federally mandated, [1] which means a Medical Assistance recipient in Pennsylvania can use Medicaid for a home birth attended by a Certified Nurse-Midwife with hospital admitting privileges or a planned-community-birth practice. This guide explains the eligibility rules and the practical search.
On this page
Sources cited (3)
- Social Security Act § 1905(a)(17)
- NACPM Medicaid Reimbursement Rates (2025)
- NASHP, Medicaid Financing of Midwifery Services (2023)
Does Pennsylvania Medicaid cover home birth?
Yes, but only when attended by a Certified Nurse-Midwife. Pennsylvania Medical Assistance, administered through the HealthChoices managed care program, covers CNM services in any setting where the CNM is licensed to practice. [1] Home birth is a covered place of service for a CNM, the same as hospital or birth-center delivery.
Pennsylvania does not recognize CPM credentialing for Medicaid billing, so CPMs cannot enroll as Medicaid providers in the state. [2] If you are on Medical Assistance and want a home birth, you need to find a CNM who attends out-of-hospital births. Pennsylvania does have CNMs in this category, though they are concentrated in metro areas.
Which midwife credentials does Pennsylvania Medicaid cover?
Pennsylvania Medicaid recognizes one midwifery credential.
Certified Nurse-Midwives (CNMs) are licensed by the Pennsylvania State Board of Medicine. CNM services are a federal Medicaid mandatory benefit under § 1905(a)(17) and are reimbursable in any setting where the CNM is licensed to practice. [1]
Certified Professional Midwives (CPMs) are not licensed in Pennsylvania, which means they cannot enroll as Medicaid providers. [2] Some Pennsylvania CPMs hold direct-entry midwifery credentials from other states or organizations, but Pennsylvania Medical Assistance won't reimburse their services.
If you want a CPM-attended home birth in Pennsylvania while on Medicaid, the practical options are: pay out of pocket for the CPM's services, hire a CNM who attends home births, or transfer Medicaid coverage to a state where CPMs are eligible providers (which is rarely a realistic move).
| CREDENTIAL | PA MEDICAID COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [1] | Hospital, birth center, home |
| Certified Professional Midwife (CPM) | No (not licensed in PA) [2] | Out-of-pocket only |
How does Pennsylvania Medicaid reimburse home birth midwives?
Pennsylvania Medicaid reimburses CNMs at a state-set fee schedule that varies between fee-for-service Medical Assistance and the HealthChoices Managed Care Organizations. According to NASHP's 50-state analysis, Pennsylvania reimburses CNMs at 75 to 98 percent of the physician rate, putting it in the middle tier of states for CNM payment parity. [3]
For global maternity care (CPT 59400), this typically lands in a competitive range that allows CNMs in metro Pennsylvania to maintain Medicaid panels. The structural barrier in Pennsylvania is the absence of CPM coverage rather than rate gaps for CNMs.
"Pennsylvania's home birth Medicaid coverage isn't held back by reimbursement, the way it is in Texas or California. The bottleneck is credentialing: until Pennsylvania licenses CPMs, the home birth midwifery community is artificially small.
On Pennsylvania's CNM-only structure
How do you find a Medicaid-accepting CNM in Pennsylvania?
HealthChoices is delivered through Managed Care Organizations like UPMC for You, AmeriHealth Caritas, Geisinger Health Plan, Highmark Wholecare, and Keystone First. Each maintains its own provider network. Pennsylvania CNMs who attend home births are concentrated in Philadelphia, Pittsburgh, and the Lancaster region.
Identify your HealthChoices MCO
Your enrollment confirmation lists your MCO. Call member services and ask: "Who is your in-network Certified Nurse-Midwife who attends home births?"
Search the PA Medical Assistance provider directory
The Department of Human Services maintains a provider directory at PA.gov. Search for "midwife" or "certified nurse-midwife" in your county.
Cross-reference with the PA chapter of ACNM
The American College of Nurse-Midwives Pennsylvania Affiliate maintains a list of practicing CNMs by region. Cross-reference with your MCO's network.
Confirm out-of-hospital practice by phone
Most CNMs in Pennsylvania practice in hospitals. The subset that attends home births is smaller. Call practices and ask specifically: "Does your CNM attend planned home births? Do you accept [my HealthChoices MCO]?"
What if no CNM in your area attends home births?
If you can't find a Medicaid-enrolled CNM with home-birth capacity in your region, three options exist:
Use a freestanding birth center. Several Pennsylvania birth centers staff CNMs and accept HealthChoices. Birth-center delivery is fully covered with the same Medicaid eligibility as hospital delivery.
Hire a CPM out of pocket plus Medicaid for hospital backup. Some Pennsylvania families hire a CPM at private-pay rates for the home birth itself, while keeping Medicaid for prenatal care and any hospital transfer. This bridges the credentialing gap at out-of-pocket cost.
File a network adequacy grievance. HealthChoices MCOs are required to provide timely access to covered services. If no CNM with home-birth capacity is available within reasonable distance, file a grievance asking the MCO to find or contract one.
Bottom line: Pennsylvania Medical Assistance covers home birth, but only when attended by a Certified Nurse-Midwife. [1] CPMs are not licensed in Pennsylvania and cannot bill Medicaid. [2] If you're on HealthChoices, focus your search on CNMs in Philadelphia, Pittsburgh, or Lancaster who attend planned home births, and cross-reference your MCO's directory with the ACNM Pennsylvania Affiliate. If no CNM in your area has capacity, freestanding birth centers and out-of-pocket CPM arrangements with Medicaid hospital backup are practical alternatives.
- Social Security Act § 1905(a)(17), 42 U.S.C. § 1396d(a)(17). Mandatory Medicaid coverage of nurse-midwife services. View source
- National Association of Certified Professional Midwives. Medicaid Reimbursement Rates by State. 2025. View source
- National Academy for State Health Policy. Medicaid Financing of Midwifery Services: A 50-State Analysis. May 2023, updated April 2026. 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.
We update articles when source data changes, when state laws are revised, or at minimum every 12 months. The "Last reviewed" date in the byline reflects the most recent review.
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