Medicaid Coverage and Reimbursement
Medicaid covers approximately half of all births in the United States, with the percent ranging from 20 to over 60 percent among states. As such, it is a key payer for midwifery services and it is critical that midwives understand when their patients may qualify for Medicaid coverage, what services are covered, and how to get paid for their services to Medicaid beneficiaries.
Available Literature and Resources
- ACNM Issue Brief on May 6, 2016 Final Regulation on Medicaid Managed Care (June 3, 2016)
- ACNM Issue Brief on June 1, 2015 Proposed Regulation on Medicaid Managed Care (June 26, 2015)
- State-by-State 2015 Medicaid CNM/CM Reimbursement for CPT Code 59400, the global code for prenatal care, vaginal birth and the postpartum visit. Note that in states where CPT code 59400 is not paid, the amount shown is a combination of 14 instances of 99213 (mid-level evaluation and management code) and 59410 (vaginal delivery and postpartum care only). Figure for Tennessee represents average reported managed Medicaid payments for 59400.
- Recording of joint ACNM/CMS webinar on CMS efforts to address maternal/infant health under Medicaid and CHIP - Note that the audio portion of the presentation begins at around the 4:00 minute mark of the recording - (July 29, 2014)
- Joint ACNM-ACOG Letter Urging Support for Medicaid (December 18, 2012)
- Medicaid Reimbursement Rates
These maps illustrate current Medicaid fee-for-service reimbursement rates for CNMs and CMs. This product was last updated in September 2013.
- Medicaid Fee-For-Service Reimbursement Rates for CNMs and CMs - Requirements of Law and Regulation as of September, 2013
- Medicaid and CHIP Payment and Access Commission
- Medicaid site maintained by CMS
- Kaiser Family Foundation's Medicaid Site
Explore the resources developed to help midwives achieve equitable Medicaid reimbursement. You must log in to view this page.