Does insurance cover a midwife or home birth?

If your midwife is a certified nurse-midwife (CNM), insurance usually covers the care. Medicaid has to cover nurse-midwife services in every state ^[1], and Marketplace plans must cover pregnancy, maternity and newborn care ^[2].

It gets harder with certified professional midwives (CPMs), other licensed midwives and planned home births. Coverage for those depends on your state's laws and on your plan. Here's how it works for each type of coverage, and how to get an answer before you sign a midwife's contract.

The short answer by type of coverage

Not sure which kind of midwife you're seeing? Our guide to CNM vs CPM vs CM explains the credentials.

Does Medicaid cover midwives?

Nurse-midwives: yes, everywhere. Federal law lists nurse-midwife services among the benefits every state Medicaid program must cover ^[1]. Medicaid pays for services the nurse-midwife is legally allowed to provide under state law, whether or not a physician supervises them ^[4]. The federal rule defines a nurse-midwife as a registered nurse who's legally authorized by the state to practice nurse-midwifery ^[8].

Birth centers: yes, if the state licenses or approves them. Freestanding birth center services are also a required Medicaid benefit ^[1]. The law covers centers that aren't hospitals and are licensed or otherwise approved by the state. States must pay the practitioners there separately, including nurse-midwives and other birth attendants the state recognizes or registers ^[4].

CPMs and other licensed midwives: it depends on the state. Medicaid payment for direct-entry midwives, including CPMs, is a state choice. As of 2023, CPMs were legally authorized to practice in 38 states and DC ^[9]. NARM's September 2023 chart listed Medicaid reimbursement for direct-entry midwives in 15 states and DC: Alaska, Arizona, California, DC, Florida, Idaho, Minnesota, New Hampshire, New Mexico, Oregon, South Carolina, Vermont, Virginia, Washington, Wisconsin and Wyoming ^[3].

That chart is three years old, and some states have changed their laws since. Confirm with your state Medicaid agency or your Medicaid health plan.

Home births: about half of states. In KFF's 2021 survey, 25 of 42 responding states covered home births under Medicaid ^[5]. Several states require a physician or CNM to attend. Texas, for example, requires a physician's prior authorization request in the third trimester for a home birth with a CNM, and New Jersey reported coverage only through two of its managed care plans ^[5].

What you pay. Medicaid can't charge cost sharing for pregnancy-related services, during pregnancy and through the end of the month in which the 60-day postpartum period ends ^[10]. See Medicaid for pregnancy by state to check eligibility.

Does private insurance cover a midwife?

CNMs are the easy case. Marketplace plans must cover pregnancy, maternity and newborn care, before and after birth ^[2]. Federal law also bars non-grandfathered plans from discriminating against a provider who's working within the scope of their state license ^[11]. That rule has limits: it doesn't force a plan to contract with every willing provider, and plans can still pay different rates ^[11]. In practice, the question is whether your CNM is in network.

Licensed midwives and birth centers depend on state law. A few states go further. Florida requires any health insurance policy that covers maternity care to also cover certified nurse-midwives, midwives licensed under state law, and licensed birth centers ^[6]. Washington requires plans to let every category of licensed provider deliver covered services within their scope of practice ^[12]. Check your state insurance department for its rules.

The self-funded catch. State insurance laws generally don't apply to self-funded employer plans, because federal law (ERISA) bars states from treating those plans as insurance companies ^[13]. In 2025, 67% of covered workers were in self-funded plans ^[14]. Ask HR whether your plan is "fully insured" or "self-funded." Only a fully insured plan has to follow your state's midwife law.

Home birth: ask directly. Ask your plan whether planned home birth is covered, which provider types it pays for a home birth, whether any are in network near you, and whether you need prior authorization.

Does TRICARE cover midwives?

TRICARE covers certified nurse-midwives certified by the American Midwifery Certification Board who hold any license their state requires. Registered nurses can also qualify with a physician's referral and supervision. TRICARE doesn't cover lay midwives, certified professional midwives or certified midwives ^[7].

How to get an out-of-network midwife or home birth covered

If your plan covers maternity care but has no in-network midwife, birth center or home birth provider near you, try this:

1. Document the gap. Search the plan's provider directory and save screenshots showing no in-network option within a reasonable distance.
2. Ask for a network gap exception. Call the plan and ask it to cover your chosen midwife at in-network rates. Plans may call this a network adequacy exception or a single-case agreement. Get any approval in writing, with a reference number.
3. Get prior authorization. If the plan requires it for maternity care or home birth, ask your midwife to submit it early in pregnancy.
4. Ask the midwife for a written estimate. It should list the global fee, what's included (prenatal visits, birth, postpartum visits, newborn care), and any separate facility or supply charges.
5. Ask about out-of-network benefits. If your plan has them, your midwife can give you a superbill to submit. Expect your out-of-network deductible and coinsurance.
6. Appeal a denial. You have 180 days from the denial notice to file an internal appeal. For care you haven't received yet, the plan must decide within 30 days ^[15].

Our guide to how much a midwife costs covers typical global fees if you end up paying some or all of the bill yourself.

What to ask your plan: a script

"I'm pregnant and want care from a midwife. Can you tell me:

• Are certified nurse-midwives in network near me? What about licensed midwives or CPMs?
• Are any freestanding birth centers in network?
• Is a planned home birth covered? Which provider types can attend it?
• Do I need prior authorization for midwifery care, a birth center birth or a home birth?
• If there's no in-network option near me, how do I request a network gap exception?
• Can I have a reference number for this call?"

If you get coverage through work, also ask HR: "Is our plan fully insured or self-funded?"

What to ask your midwife

• What's your credential, and are you licensed in this state? CNM, CM, CPM and licensed midwife (LM) are different credentials with different coverage rules.
• Do you bill my insurance or Medicaid? Ask whether they're in network with your specific plan.
• What does your fee include, and what happens if I transfer to a hospital? Ask who bills for hospital care and whether any part of the fee is refunded.
• Can you give me a superbill? You'll need one to file an out-of-network claim.

When you're ready, find a midwife or find a birth center in your state.