Does South Carolina Medicaid Cover Home Birth? 2026 Healthy Connections Coverage and the Licensed Midwife Pathway
Yes, through two pathways. Healthy Connections covers Certified Nurse-Midwife services as a federal mandatory benefit, [1] and SCDHHS sponsors the enrollment of Licensed Midwives as Medicaid providers, with home birth billing spelled out in its provider manual: all LM claims carry an SB modifier, a home delivery supply code exists, and every LM must have a Medicaid-enrolled physician credentialed in obstetrics providing back-up. [3] About 60 percent of South Carolina births are covered by Healthy Connections. [2] Confirm your specific plan's rules and your midwife's enrollment before committing.
South Carolina has a long tradition of community midwifery, particularly in the Lowcountry around Charleston, Beaufort, and the Sea Islands. The state's Medicaid program covers about 60 percent of all South Carolina births, [2] and unlike most Southern states, it maintains a documented billing pathway for Licensed Midwife home birth: SCDHHS enrolls LMs as providers, publishes their billing rules, and even reimburses a home delivery supply code. [3] The condition that trips families up is the physician back-up requirement. This guide walks through both the CNM and LM pathways.
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Sources cited (5)
- Social Security Act § 1905(a)(17)
- SCDHHS Maternal Health Care Grant (2025)
- SCDHHS Physicians Provider Manual (2025)
- MACPAC Midwives and Birth Centers (2023)
- NASHP, Medicaid Financing of Midwifery Services (2023)
Does South Carolina Medicaid cover home birth?
Yes, when the billing rules are met. Healthy Connections (the South Carolina Medicaid program) covers Certified Nurse-Midwife services as a federal mandatory benefit, [1] and SCDHHS separately sponsors the enrollment of Licensed Midwives, the non-nurse credential that attends most South Carolina home births. [3] MACPAC lists South Carolina among the 14 state Medicaid programs that cover certified professional midwives. [4]
The SCDHHS Physicians Services Provider Manual documents the LM pathway in detail: LMs file all claims with an SB modifier, bill a dedicated supply code for home deliveries, perform the newborn exam, and handle newborn screening duties when no physician attends. [3]
The load-bearing condition is physician back-up. Before Medicaid pays an LM's prenatal claims, the midwife must submit signed documentation from a Medicaid-enrolled physician credentialed in obstetrics who agrees to provide back-up: two assessment visits, prescriptions for delivery medications, medical evaluation if complications arise, and emergency delivery services. The physician's hospital privileges must be documented with SCDHHS. [3] Midwives without a back-up arrangement cannot bill. That single requirement explains most of the gap between the policy on paper and what families experience, so ask any midwife about their back-up physician before assuming coverage.
Which midwife credentials does South Carolina Medicaid cover?
South Carolina recognizes two midwifery credentials, and both have Medicaid pathways.
Certified Nurse-Midwives (CNMs) are advanced practice registered nurses certified by the American Midwifery Certification Board. CNM services are a federal Medicaid mandatory benefit, [1] and SCDHHS defines their covered scope to include pregnancy, childbirth, postpartum, and normal newborn care for the first 28 days. CNMs performing medical acts work under a practice agreement in compliance with the state Nurse Practice Act. [3]
Licensed Midwives (LMs) are non-nurse midwives licensed by the South Carolina Department of Public Health under Regulation 61-24, serving low-risk women with defined prenatal, delivery, and postpartum services. [3] Most SC LMs hold the NARM Certified Professional Midwife credential. Medicaid sponsors LM enrollment as providers, [3] and MACPAC counts South Carolina among the 14 CPM-covering state Medicaid programs. [4] The working constraints: an OB-credentialed back-up physician must sign on, the home must be certified as an acceptable birth environment, and an emergency transport plan must be documented. [3]
| CREDENTIAL | SC MEDICAID COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [1] | Hospital, birth center, home |
| Licensed Midwife (LM) | Yes, with physician back-up on file [3] | Birth center or home |
| NARM CPM credential | Held by most LMs; billing runs through the LM license [3] | Bundled with state licensure |
How does South Carolina Medicaid reimburse home birth midwives?
Healthy Connections runs on fee-for-service Medicaid plus five managed care organizations: Absolute Total Care, First Choice by Select Health, Healthy Blue, Humana Healthy Horizons, and Molina Healthcare. Each MCO administers benefits for its members within SCDHHS guidelines, so LM billing experience can vary by plan.
The billing mechanics for LMs are specific: every procedure code carries the SB modifier, initial prenatal claims must include the signed physician back-up documentation, a dedicated supply code reimburses home delivery supplies on top of the vaginal delivery code, and the newborn exam bills with the SB modifier too. LMs collect newborn metabolic screening specimens when no physician attends, and pulse oximetry screening is required for babies born at home. [3]
For CNM reimbursement, NASHP's 50-state analysis found about half of states pay CNMs at 100 percent of physician rates, with most of the rest between 75 and 98 percent; check the current SCDHHS fee schedules for exact amounts. [5] Midwife practices with recent Healthy Connections billing experience remain the best source on which services pay reliably under each MCO.
How do you find a Medicaid-accepting midwife in South Carolina?
South Carolina's home birth midwifery community is concentrated in Charleston, the Lowcountry, Columbia, and Greenville. Charleston has the deepest pool of Licensed Midwives.
Identify your Healthy Connections plan
Your enrollment confirmation lists your MCO: Absolute Total Care, First Choice by Select Health, Healthy Blue, Humana Healthy Horizons, or Molina. Plans differ in midwife network experience. SCChoices.com handles plan selection and switches.
Search for licensed midwives by region
Home Birth Partners maintains a South Carolina directory, and the SC Department of Public Health licenses LMs under Regulation 61-24, so verify any candidate's license status directly with the state. Most LMs serve the Charleston metro and the Lowcountry.
Ask about billing and physician back-up
Ask each midwife two questions: "Have you billed [my Healthy Connections plan] for home birth services in 2025 or 2026?" and "Who is your back-up physician, and is that arrangement on file with SCDHHS?" A midwife without documented physician back-up cannot bill Medicaid. [3]
Confirm current policy with SCDHHS
Call SCDHHS Member Services at (888) 549-0820 and ask: "Does my plan reimburse Licensed Midwives for planned home birth, and what do I need on file?" Document the answer with date and reference number.
What if your Healthy Connections plan doesn't cover LM home birth?
If your MCO can't confirm LM home birth reimbursement, or the midwives near you lack physician back-up arrangements, four options exist:
Find a CNM offering planned home birth. South Carolina CNMs who attend home births are fewer than LMs but exist, especially around Charleston. CNM care is the federally mandated pathway. [1]
Use a freestanding birth center. Medicaid contracts with birthing centers in South Carolina, [3] and several are staffed by CNMs and LMs. Birth center delivery keeps you out of the hospital while staying inside the covered system.
Switch MCOs. SCDHHS allows Healthy Connections members to change MCOs during open enrollment or after qualifying events, through SCChoices.com. If a different MCO has better midwife network experience, switching is a legitimate path.
Pay out of pocket plus Medicaid for back-up. Some SC families pay privately for an LM's home birth attendance while keeping Medicaid for prenatal labs, ultrasounds, and any hospital transfer. Hospital transfer and the newborn's coverage don't depend on how you paid the midwife.
For a full guide to home birth midwives in South Carolina, including licensing, costs by region, and what to ask before hiring, see our South Carolina home birth midwife guide.
Bottom line: South Carolina Healthy Connections covers CNM-attended birth as a federal mandatory benefit [1] and runs a documented Licensed Midwife pathway: SCDHHS enrolls LMs, requires an SB modifier on every claim, reimburses home delivery supplies, and conditions everything on a Medicaid-enrolled OB back-up physician being on file. [3] MACPAC counts South Carolina among the 14 CPM-covering state Medicaid programs. [4] Charleston and the Lowcountry have the deepest LM community. Confirm two things before committing: your plan's answer in writing from SCDHHS, and your midwife's back-up physician arrangement.
- Social Security Act § 1905(a)(17), 42 U.S.C. § 1396d(a)(17). Mandatory Medicaid coverage of nurse-midwife services. View source
- South Carolina Department of Health and Human Services. SCDHHS Receives Grant to Invest in Maternal Health Care. January 2025. View source
- South Carolina Department of Health and Human Services. Physicians Services Provider Manual. September 1, 2025. View source
- Medicaid and CHIP Payment and Access Commission. Access in Brief: Access to Maternity Providers: Midwives and Birth Centers. May 2023. View source
- National Academy for State Health Policy. Medicaid Financing of Midwifery Services: A 50-State Analysis. May 2023. 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.
If you spot an error or have a primary source we should add, email [email protected].