Does Virginia Cardinal Care Cover Home Birth?2026 Coverage Through Cardinal Care Managed Care and the Five Health Plans
Yes for CNMs. Virginia Cardinal Care (the rebranded 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] Coverage is administered through five Cardinal Care Managed Care health plans, each with its own provider network. CPM Medicaid coverage in Virginia is more limited than CNM coverage; confirm with each midwife and your specific Cardinal Care plan.
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] but the practical coverage of home birth depends on whether your specific Cardinal Care health plan has an in-network home-birth midwife. CNM coverage is reliable; CPM coverage is more constrained.
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Sources cited (3)
- Cover VA Cardinal Care Pregnancy Coverage
- Social Security Act § 1905(a)(17)
- Virginia DMAS Cardinal Care Update
Does Cardinal Care cover home birth?
Yes for CNMs. 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.
Coverage is delivered 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. The practical answer for any specific family depends on which Cardinal Care plan they're enrolled in and whether that plan has an in-network home-birth-attending CNM.
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) are licensed by the Virginia Board of Medicine. Virginia CPMs hold the NARM credential plus state-specific licensure. While Virginia licenses CPMs and recognizes them as legal home-birth practitioners, CPM Medicaid coverage in Virginia is more limited than CNM coverage. Most Virginia CPMs report that Cardinal Care plans do not reliably reimburse for CPM-attended home birth, though specific MCO contracts may include some CPM providers.
| CREDENTIAL | VA MEDICAID COVERAGE | PRACTICE SETTING |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [2] | Hospital, birth center, home |
| Certified Professional Midwife (CPM) | Limited; varies by Cardinal Care plan | Birth center or home |
| Birth center facility | Covered when enrolled | Freestanding birth center |
How does Cardinal Care reimburse home birth midwives?
Cardinal Care reimbursement is administered through five MCO contracts. Each MCO sets its own provider rates within DMAS guidelines. CNM reimbursement (CPT 59400 global maternity care) follows the standard fee schedule.
CPM reimbursement, where it occurs at all in Virginia, is plan-specific and often requires prior authorization. Virginia CPMs report that successful Medicaid billing for CPM-attended home birth is rare and depends heavily on specific MCO arrangements. The structural pattern is: CNM coverage works smoothly; CPM coverage is the exception rather than the rule.
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." Note both CNM and CPM listings; CPMs in the directory may not be Medicaid-billable depending on the plan.
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 a Medicaid-billing provider for [my Cardinal Care plan], and do you attend planned home births?" CNMs offering planned home birth are the most reliable Medicaid-covered option.
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. Virginia allows Cardinal Care members to change MCOs during open enrollment or after a qualifying life event (pregnancy is a qualifying event). 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 fully covered with the same Medicaid eligibility as hospital delivery.
Pay out of pocket for a CPM plus Cardinal Care for prenatal/transfer. Some Virginia families pay private-pay for a CPM home birth attendance while keeping Cardinal Care for prenatal labs, ultrasounds, and any hospital transfer. This is the standard workflow when CPM Medicaid billing isn't available.
Bottom line: Virginia Cardinal Care covers CNM-attended home birth as a federal mandatory benefit. [1,2] CPM coverage in Virginia is limited and varies by Cardinal Care plan; most Virginia CPMs report that successful Medicaid billing is rare. Northern Virginia has the deepest pool of home-birth-attending CNMs. Use your Cardinal Care plan's directory plus the Virginia Midwifery Council, confirm panel status by phone, and consider CNM-staffed birth centers as a fully-covered fallback if no in-network home birth midwife is available.
- 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
▶ How we research and review this content Editorial standards
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].