Midwife Medicaid Reimbursement Policies by State

April 15, 2022

Access to maternity care is key to addressing the maternal mortality crisis. Midwife services can bridge gaps in health care, reduce health disparities, and support maternal and neonatal wellbeing.

This interactive map summarizes state Medicaid reimbursement policies for all types of midwives including certified nurse-midwives (CNMs) and midwives who pursue alternative pathways to licensure, often referred to as certified professional midwives (CPMs), certified midwives (CMs), or direct entry midwives depending on state regulations.

The accompanying tables provide a detailed description of individual state midwife policies, including licensure for some midwives. You can also download the charts on Certified Nurse-Midwife State Medicaid Reimbursement Policy and Midwife Licensing and State Medicaid Reimbursement Policy.

Read the accompanying case study: Improving Birthing Outcomes through Midwifery Care: New Mexico

For questions or updates related to this research, please reach out to Emily Creveling at ecreveling@oldsite.nashp.org.

DEFINITIONS

For the purposes of this chart and map:

Midwives refers to midwives without a nursing degree. Terminology for midwives without a nursing degree varies across states. Examples include: licensed midwives, direct entry midwives, certified professional midwives, and more.
Certified nurse-midwives refers to midwives with a nursing degree.

Certified Nurse-Midwife State Medicaid Reimbursement Policy

State	Independent or Collaborative Practice	Medicaid Reimbursement	Can Serve as Primary Care Provider in Medicaid	Global Maternity Payment Includes Certified Nurse- Midwife Services	Expanded Certified Nurse-Midwife Services Reimbursed	Specific Certified Nurse-Midwife Fee Schedule	Included as Eligible Providers in Medicaid Payment Reform Initiatives
Alabama	Collaborative	Y (80% of physician rate)	Y	Y	Y	N	Y
Alaska	Independent	Y (85% of physician rate)	Y	N	–	N	–
Arizona	Independent	Y (90% of physician rate)	Y	Y	–	N	Y
Arkansas	Collaborative	Y (80% of physician rate)	N	N	–	Y	–
California	Independent	Y (100% of physician rate)	Y	Y	Y	Y	Y
Colorado	Independent	Y (100% of physician rate)	N	–	–	N	Y
Connecticut	Collaborative	Y (100% of physician rate)	N	Y	Y	N	Y
Delaware	Collaborative	Y (100% of physician rate)	N	–	–	N	–
District of Columbia	Independent	Y (100% of physician rate)	Y	N	N	N	N
Florida	Hybrid model (restrictions in place)	Y (80% of physician rate)	N	N	Y (Healthy Start Prenatal Risk Screening (SUD/mental health screening) and Screening, Brief Intervention, and Referral to Treatment or SBIRT)	Y	N
Georgia	Collaborative	Y (100% of physician rate)	N	Y	Y (Screening and care coordination; for treatment services, CNMs refer the members to substance use or mental health professionals)	N	N
Hawaii	Independent	Y (75% of physician rate)	Y	Y (Pregnancy and delivery are covered as a global service)	Y	N	N
Idaho	Independent	Y (85% of physician rate, except for services provided in a RHC, FQHC, or Indian Health Service)	N	Y	N	N	Y
Illinois	Collaborative	Y (100% of physician rate)	Y	N	Y	N	N
Indiana	Collaborative	Y (75% of physician rate)	Y (Within managed care programs)	N/A	Y (Well woman exams and family planning. Depending on qualifications, some may provide SUD and other behavioral health services)	N	Y
Iowa	Independent	Y (85% of physician rate)	Y	Y	Y (SUD screening and treatment, mental health screening and treatment, and care coordination)	N	Y
Kansas	Independent	Y (75% of physician rate)	Y	Y	Y	N	N
Kentucky	Collaborative	Y (75% of physician rate)	Y	N	Y (Additional services may be approved on a case-by-case basis by the Medical Director)	N	N
Louisiana	Collaborative	Y (80% of physician rate; 100% for: EPSDT services, physician administered medication, and long-acting reversible contraceptives)	N	N	Y (Physical and some behavioral health services)	N	Y
Maine	Independent	Y	–	–	–	–	–
Maryland	Independent	Y (100% of physician rate)	Y	N	Y (SUD screening and treatment, mental health screening and treatment, and care coordination paid as part of enriched maternity services)	N	Y (CNMs are considered eligible providers for certain VBP metrics).
Massachusetts	Collaborative	Y (85% of physician rate)	Y	Y	N	Y	Y
Michigan	Collaborative	Y (100% of physician rate)	Y	Y	Y (Behavioral health, reproductive health, and SUD screening and treatment services)	Y	N
Minnesota	Independent	Y (100% of physician rate)	Y	Y	Y	N	Y
Mississippi	Collaborative	Y (90% of physician rate)	N	N	Y (SUD screeningand home visiting services)	N	Varies by Coordinated Care Organization (CCO)
Missouri	Collaborative	Y (100% of physician rate)	Y	Y (This applies to vaginal deliveries. CNMs are not allowed to bill for Caesarean Section global payments)	Y (Family planning, counseling, birth control technique well-woman gynecological care, and some infant care midwife services)	Y	Y
Montana	Independent and/or collaborative	Y (90% of physician rate)	N	Y	Y (Mental health screening and treatment, and caregiver health risk assessment)	N	N
Nebraska	Collaborative	Y	–	–	–	–	–
Nevada	–	Y	–	–	Y (Smoking cessation services, home visiting services)	–	–
New Hampshire	Independent	Y (100% of physician rate)	N	Y	Y (SUD screening, mental health screening, well woman exams, family planning)	N	N
New Jersey	Update pending	Update pending	Update pending	Update pending	Update pending	Update pending	Update pending
New Mexico	Independent	Y (100% of physician rate)	Y	Y	Y (Same as physician covered services)	N	N
New York	Independent	Y (85% of physician rate)	Y	–	–	Y	–
North Carolina	Collaborative	Y (98% of physician rate)	Y	Y	Y (SUD screening, mental health screening, care management for high risk pregnancies (CMHRP))	Y	Y
North Dakota	Independent	Y (75% of physician rate for FFS; 85% of physician rate for MCO)	Y	Y (MCO); N (FFS)	Y	N	Y (MCOs); N (FFS)
Ohio	Collaborative	Y (100% of physician rate)	Y	Y	Y (Depending on service setting)	N	Y
Oklahoma	Independent	Y (100% of physician rate)	N	Y	Y (SBIRT, smoking cessation)	N	N
Oregon	Independent	Y (100% of physician rate)	Y	Y (Global OB package applies when all prenatal care, delivery, and postpartum care is provided by one midwife)	Y (Depending on service setting)	N	N
Pennsylvania	Collaborative	Y (100% of physician rate)	Y	Y	Y (SUD screening and treatment, mental health screening and treatment, care coordination (service referral), tobacco cessation counseling)	N	Y
Rhode Island	Independent	Y (100% of physician rate)	Y	Y	Y (SUD screening, mental health screening, care coordination (service referral)	N	Y
South Carolina	Collaborative	Y (100% of physician rate)	N	N	N	Y	N
South Dakota	Independent	Y (100% of physician rate)	Y	Y	Y (Mental health screening)	N	Y
Tennessee	Collaborative	Y (% varies by MCO)	Y	Y	Y (Reimbursable services vary by MCO)	Varies by MCO	Y
Texas	Collaborative	Y (92% of physician rate, except 100% of physician rate for laboratory services, x-ray services)	Y (MMC)	N	Y (See the Texas Medicaid Provider Procedures Manual for CNM reimbursable services)	Y	Y (Varies by MCO)
Utah	Independent	Y (100% of physician rate)	Y	Y	Y (SUD screening, mental health screening and treatment, other reproductive health services)	N	N
Vermont	Independent	Y (100% of physician rate)	Y	Y	Y	N	Y
Virginia	Hybrid model (restrictions)	Y (100% of physician rate)	N	N (FFS); Y (Varies by MCO)	N (FFS); Y (MCO) (Well woman exams and family planning)	N	N (FFS); Y (Varies by MCO)
Washington	Independent	Y	Y	Y	Y (SUD screening, mental health screening, care coordination service referral)	N	Y
West Virginia	Collaborative	Y (100% of physician rate)	–	–	–	N	–
Wisconsin	Collaborative	Y (90% of physician rate; 100% if CNM holds a Master’s degree)	Y	Y	N	Y	Y
Wyoming	Independent	Y (100% of physician rate)	N	Y	Y (SUD screening)	N	N

Midwife Licensing and State Medicaid Reimbursement Policy

State	Type of Midwife	Licensing Board/ Licensure Requirements	Midwife Medicaid Reimbursement	Provider Requirements	Global Maternity Payment includes Midwifery Services	Expanded Midwifery Services Reimbursed	Midwife-Specific Fee Schedule	Midwives Included as Eligible Providers in Medicaid Payment Reform Initiatives
Alaska	Direct Entry Midwife	State Board of Certified Direct-Entry Midwives Requirements	Y	–	Y	–	Y	–
Arizona	Licensed Midwife	Bureau of SpecialLicensure, Arizona Department of Health Services Requirements	Y	–	N	–	Y	N
California	Licensed Midwife	Medical Board of CA Requirements	Y	Enrollment requirements	N	Y	N (Fall under Non Physician Medical Practitioner)	N
Florida	Licensed Midwife	Department of Health: Council of Licensed Midwifery Requirements	Y	Enrollment in Medicaid with appropriate licensure	N	Y (Prenatal risk and SUD/mental health screening)	Y	N
Louisiana	Licensed Midwife	Louisiana State Board of Medical Examiners Requirements	Y (Covered vaginal delivery services only when provided at a Medicaid Free-Standing Birthing Center)	Enrollment in Medicaid with the appropriate licensure and certification	N	N	N	N
Minnesota	Traditional Midwife	Board of Medical Practice Requirements	Y	Enrollment requirements	Y	Y (Any services that are billable by a free-standing birth center are reimbursable for a midwife)	N	N
Montana	Direct Entry Midwife	Department of Labor and Industry Requirements	Y	–	Y	N	Y	N
New Hampshire	New Hampshire Certified Midwife (NHCM)	New Hampshire Midwifery Council Requirements	Y	Requirements	Y	N	N	N
New Jersey	Policies are in the process of being updated as the state finalizes implementation of SFY22 budget language for midwifery coverage (see Public Notice).	Update pending	Update pending	Update pending	Update pending	Update pending	Update pending	Update pending
New Mexico	Licensed Midwife	New Mexico Department of Health Public Health Division Maternal Health Program Requirements	Y	Requirements	Y (See Supplemental 19-03)	Y (Family planning services)	Y	N
New York	Licensed Midwife	Board of Regents and the State Education Department (SED) Requirements	Y	–	–	–	Y	–
Oregon	Licensed Direct-Entry Midwife	Board of Direct-Entry Midwifery Requirements	Y	Requirements	Y (Oregon’s FFS program pays the same global maternity rate regardless of provider type or setting. Since community birth is carved out of managed care (CCOs), the global payment is the same for all providers including licensed direct- entry midwifes.)	Y (Family planning services)	N	N
Oregon	Traditional Midwife	Board of Direct-Entry Midwifery Requirements	N	N/A	N/A	N/A	N/A	N/A
Rhode Island	Certified Midwife	Advisory Council on Midwifery Requirements	Y	–	–	–	–	–
Rhode Island	Certified Professional Midwife	Advisory Council on Midwifery Requirements	Y	–	–	–	–	–
South Carolina	Certified Professional Midwife	South Carolina Department of Health and Environmental Control (SCDHEC) Requirements	Y	Must meet SCDHEC requirement. Then goes through standard Medicaid provider enrollment process.	N	N	Y	N
Texas	Licensed Direct-Entry Midwife	Texas Midwifery Board Requirements	Y (70% of physician reimbursement rate)	Requirements Additional Requirements	N	Y	Y	Y
Vermont	Licensed Midwife	Office of Professional Regulation Requirements	Y	They must enroll to be a Vermont Medicaid provider and meet all the requirements of 42 CFR § 455 Subpart B and E.	Y	Y	N	Y (OneCare network)
Virginia	Licensed Midwife	Board of Medicine of Virginia Requirements	Y	FFS: The requirement is that the provider is licensed as a Nurse Practitioner by the Department of Health Professions with the specialty of Certified Nurse Midwife. Managed Care: MCOs do not contract with non-certified nurse midwives.	N/A	N/A	N	N/A
Washington	Licensed Midwife	Washington Department of Health (DOH) Requirements	Y	Active licensure with DOH and be a contracted provider with Medicaid.	Y	Y (SUD screening, mental health screening)	Y	Y
Wyoming	Licensed Midwife	Board of Midwifery Requirements	Y	Enrollment application completed with a copy of licensure/certification and financial forms.	Y	N	N	N

Note: In these charts, “-” indicates “information not available.”

Acknowledgments: This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC31658; $398,953. This information, content, and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.