Does Virginia Cardinal Care Cover Home Birth? 2026 Coverage for CNMs and Licensed Midwives Under Cardinal Care Managed Care
Yes. Virginia Cardinal Care (the current name for Virginia Medicaid and FAMIS) covers care from a doctor or midwife as part of pregnancy services. [1] CNM services are a federal Medicaid mandatory benefit. [2] Virginia also licenses CPMs as licensed midwives and reimburses them through Medicaid, but licensed midwife claims pay through fee-for-service, not through the five Cardinal Care Managed Care plans. [4] Members who want a licensed midwife home birth usually need to move from managed care to fee-for-service first; confirm the steps with Cover Virginia and your midwife. [6]
Virginia rebranded its Medicaid program to Cardinal Care in 2023, and as of 2024 the state has rolled out Cardinal Care Managed Care (CCMC) as a unified delivery model. [3] Pregnant Virginians on Cardinal Care receive maternal health coverage that includes midwife care, prenatal visits, and delivery. [1] CNM coverage runs through every Cardinal Care plan. Licensed midwives (CPMs) are covered too, with a catch: MCOs generally do not contract with them, so licensed midwife care pays through fee-for-service Medicaid, and switching out of a managed care plan takes time and paperwork. [4,6]
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Sources cited (7)
- Cover VA Cardinal Care Pregnancy Coverage
- Social Security Act § 1905(a)(17)
- Virginia DMAS Cardinal Care Update
- NASHP Midwife Licensing and Reimbursement Chart (2022)
- DMAS Maternal Health Bulletin (July 2025)
- Cardinal News on VA Midwife Medicaid Access (2026)
- Virginia Board of Medicine, Licensed Midwife
Does Cardinal Care cover home birth?
Yes for CNMs, and yes for licensed midwives through fee-for-service. Cardinal Care provides health coverage to pregnant members that includes medical visits, care from a doctor or midwife, prenatal and postpartum visits, and general and specialty care. [1] CNM services are a federal Medicaid mandatory benefit and are reimbursable in any setting where the CNM is licensed to practice, [2] including planned home birth.
Most members get coverage through Cardinal Care Managed Care plans (Aetna Better Health Virginia, Anthem HealthKeepers Plus, Molina Complete Care, Sentara Community Plan, United Healthcare Community Plan). [3] Each plan administers Medicaid for its members and maintains its own provider network. For a CNM-attended home birth, the practical answer depends on which plan you're enrolled in and whether it has an in-network home-birth-attending CNM.
Licensed midwives (Virginia's CPM credential) are covered under a different pathway. NASHP's state chart lists Virginia among the states whose Medicaid programs reimburse midwives without a nursing degree, with one structural limit: MCOs do not contract with midwives who are not CNMs, so licensed midwife claims run through fee-for-service Medicaid. [4] To use a licensed midwife for a Medicaid-covered home birth, most members must first ask to move from their managed care plan to fee-for-service. Reporting on the 2026 legislative session describes that process as taking months for some families, so start early. [6]
Which midwife credentials does Cardinal Care cover?
Virginia recognizes two midwifery credentials.
Certified Nurse-Midwives (CNMs) are licensed by the Virginia Board of Nursing as advanced practice registered nurses. CNM services are a federal Medicaid mandatory benefit under § 1905(a)(17), [2] and Cardinal Care plans are required to include them as covered providers.
Certified Professional Midwives (CPMs) hold the NARM credential and are licensed by the Virginia Board of Medicine as licensed midwives; the state has licensed them since December 2005. [7] Virginia Medicaid reimburses licensed midwives, and since July 1, 2025 it must pay them the same amount paid to a physician or CNM for the same service, whichever is higher, under Item 288.PPPPP of the 2025 Appropriation Act. [5] The limit is the delivery system: Cardinal Care MCOs generally do not contract with non-CNM midwives, so licensed midwife claims pay through fee-for-service. [4] Virginia has more than 500 licensed midwives, but many do not accept Medicaid, so confirm enrollment with each practice. [6]
| CREDENTIAL | VA MEDICAID COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [2] | Hospital, birth center, home |
| Certified Professional Midwife (CPM / Licensed Midwife) | Yes via fee-for-service; MCOs generally do not contract [4,5] | Birth center or home |
| Birth center facility | Covered when enrolled | Freestanding birth center |
How does Cardinal Care reimburse home birth midwives?
Cardinal Care reimbursement runs through five MCO contracts for most members, plus a fee-for-service pathway administered directly by DMAS. CNM reimbursement (CPT 59400 global maternity care) follows the standard fee schedule inside each plan's network.
Licensed midwife reimbursement changed on July 1, 2025. Under Item 288.PPPPP of the 2025 Appropriation Act, DMAS must reimburse a licensed midwife or licensed certified midwife the same amount paid to a physician or CNM for the same service, whichever is higher. [5] That closed a long-standing pay gap. What has not changed: MCOs generally do not contract with non-CNM midwives, so licensed midwife claims still run through fee-for-service, and members in a managed care plan usually need to opt out before the birth for the claim to pay. [4,6] A budget amendment proposed in the 2026 session would create a state workgroup on the MCO contracting barrier. [6]
How do you find a Cardinal Care-accepting midwife in Virginia?
Virginia's home birth midwifery community is concentrated in Northern Virginia (Arlington, Alexandria, Fairfax), Richmond, Hampton Roads, and the Charlottesville-Roanoke corridor. The Virginia Midwifery Council and individual practices are useful starting points.
Identify your Cardinal Care MCO
Your enrollment confirmation lists which of the five Cardinal Care plans you're on. Plans differ in their midwife network coverage, especially for out-of-hospital practitioners.
Pull your plan's midwife provider directory
Search your plan's online directory for "midwife" or "certified nurse-midwife." Plan directories list network providers only. Licensed midwives usually bill fee-for-service instead, so a midwife can be Medicaid-billable without appearing in any plan directory. [4]
Cross-reference with state midwife directories
The Virginia Midwifery Council and Home Birth Partners both maintain provider directories. Cross-reference with your Cardinal Care plan's network.
Confirm Medicaid panel and out-of-hospital scope by phone
Ask each practice: "Are you enrolled with Virginia Medicaid, do you bill through my Cardinal Care plan or through fee-for-service, and do you attend planned home births?" CNMs offering planned home birth are the simplest in-plan option; licensed midwives can be covered too, but usually only after you move to fee-for-service. [4,6]
What if your Cardinal Care plan doesn't have a home-birth midwife in-network?
Three options exist if no in-network home-birth-attending midwife is available:
Switch Cardinal Care plans. Cardinal Care members can request a plan change at set times each year and for approved reasons; call Cover Virginia to ask what applies to your case. If a different plan has more midwives in-network, switching is a legitimate path.
Use a freestanding birth center. Virginia birth centers in Northern Virginia, Richmond, and Hampton Roads staff CNMs and accept Cardinal Care. Birth-center delivery is covered with the same Medicaid eligibility as hospital delivery; confirm the specific center is in your plan's network.
Move to fee-for-service and hire a licensed midwife. Virginia Medicaid reimburses enrolled licensed midwives through fee-for-service, at parity rates since July 2025. [4,5] Ask your MCO how to disenroll to fee-for-service, then confirm the midwife is enrolled with Virginia Medicaid and expects the claim to pay before you sign a contract. The switch can take months, so start in the first trimester. [6] Some families still pay privately when the timing doesn't work, keeping Cardinal Care for prenatal labs, ultrasounds, and any hospital transfer.
For a full guide to home birth midwives in Virginia, including licensing, costs by region, and what to ask before hiring, see our Virginia home birth midwife guide.
Bottom line: Virginia Cardinal Care covers CNM-attended home birth as a federal mandatory benefit, [1,2] and Virginia Medicaid also reimburses licensed midwives (CPMs), at parity rates since July 1, 2025. [4,5] The structural catch: MCOs generally do not contract with non-CNM midwives, so licensed midwife home birth pays through fee-for-service, and moving out of managed care takes time. [4,6] Northern Virginia has the deepest pool of home-birth midwives. Use your Cardinal Care plan's directory for CNMs, confirm Medicaid enrollment with any licensed midwife by phone, and consider CNM-staffed birth centers as a covered fallback if no home birth midwife works out.
- Virginia Department of Medical Assistance Services. Cardinal Care Pregnancy and Postpartum Coverage. View source
- Social Security Act § 1905(a)(17), 42 U.S.C. § 1396d(a)(17). Mandatory Medicaid coverage of nurse-midwife services. View source
- Virginia Department of Medical Assistance Services. General Update on Cardinal Care, Including Changes Under Cardinal Care Managed Care. View source
- National Academy for State Health Policy. Midwife Licensing and State Medicaid Reimbursement Policies. April 2022. View source
- Virginia Department of Medical Assistance Services. Maternal Health Bills and Budget Items Effective July 1, 2025. View source
- Cardinal News. The Pulse: Lawmakers Look at Maternal Health Gaps as Rural Services Shrink. February 12, 2026. View source
- Virginia Department of Health Professions, Board of Medicine. Licensed Midwife. 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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