Does Texas Medicaid Cover Home Birth?2026 Coverage, Documented Midwife Status, and Reimbursement Reality
Yes. Texas Medicaid covers home birth attended by Certified Nurse-Midwives and by Documented Midwives (Texas's state-licensed direct-entry midwife credential). [1] Reimbursement is one of the lowest in the country: Texas Medicaid pays at 66 percent of Medicare physician rates, and CNMs receive 92 percent of that figure. [2] Home birth coverage is real on paper but practical access is limited by Texas's reimbursement gap and provider scarcity.
Texas covers approximately half of all U.S. births through Medicaid, more than any other state. [3] But the gap between what Texas Medicaid covers on paper and what families can actually access for a home birth is wide. This guide explains both: the coverage rules under §354.1251 of the Texas Administrative Code, and the reimbursement and access reality on the ground.
On this page
Sources cited (4)
- 1 TAC §354.1251 (Texas Medicaid Midwife Services)
- ACNM Reimbursement Equity Tracker
- KERA News, Texas Medicaid Maternal Health (2023)
- Social Security Act § 1905(a)(17)
Does Texas Medicaid cover home birth?
Yes. Texas Medicaid covers home birth services under §354.1251 of the Texas Administrative Code, which governs midwife services in the state's Medicaid program. [1] Both Certified Nurse-Midwives and Documented Midwives (the Texas state-licensed direct-entry midwifery credential) are eligible Medicaid providers when they're enrolled in the Texas Medical Assistance Program.
The nuance worth knowing: when national sources list Texas in the "states that cover CPMs," they're really referencing this Documented Midwife provider category. Texas doesn't separately license CPMs as such , anyone holding a CPM credential who wants to bill Texas Medicaid must also hold a Texas Documented Midwife license issued by the Texas Department of Licensing and Regulation under Title 22, Part 41 of the Texas Administrative Code.
Which midwife credentials does Texas Medicaid cover?
Texas Medicaid recognizes two midwifery credentials.
Certified Nurse-Midwives (CNMs) are licensed by the Texas Board of Nursing as advanced practice registered nurses. CNM services are a federal Medicaid mandatory benefit under § 1905(a)(17) and are reimbursable in any setting where the CNM is licensed to practice. [4]
Documented Midwives (DMs) are licensed by the Texas Department of Licensing and Regulation under Title 22, Part 41. The DM credential is Texas's pathway for non-nurse direct-entry midwives. To bill Texas Medicaid, a DM must be enrolled and approved as a Medicaid provider through TMHP (Texas Medicaid & Healthcare Partnership).
Unlicensed midwives cannot bill Texas Medicaid regardless of training or experience. CPM credential holders who want to practice in Texas typically pursue a DM license alongside their national CPM credential.
| CREDENTIAL | TX MEDICAID COVERAGE | WHERE THEY PRACTICE |
|---|---|---|
| Certified Nurse-Midwife (CNM) | Yes (federal mandate) [4] | Hospital, birth center, home |
| Documented Midwife (DM) | Yes if Medicaid-enrolled [1] | Birth center or home |
| CPM (national credential alone) | No, requires DM license | Birth center or home |
How much does Texas Medicaid reimburse for home birth?
Texas Medicaid reimbursement is among the lowest in the country. The structural math: Texas Medicaid sets its physician rate at 66 percent of Medicare's physician rate. CNMs receive 92 percent of the Texas Medicaid physician rate, which compounds to about 60 percent of the Medicare physician rate. [2]
For global maternity care (CPT 59400), this typically lands in the $1,800 to $2,400 range, depending on managed care contract specifics. Private-pay home birth in Texas typically runs $4,500 to $6,500.
The reimbursement gap explains why many Texas home birth midwives don't accept Medicaid clients. Solo practitioners often can't sustain a practice on Medicaid pay alone, and Texas hasn't passed reimbursement parity legislation to bring rates closer to private insurance levels.
How do you find a Medicaid-accepting midwife in Texas?
Texas's STAR Medicaid Managed Care plans (Superior, Molina, Aetna Better Health, etc.) each maintain provider directories. The reality is that midwife listings in those directories are often outdated , the practical path is to call midwives directly.
Identify your STAR plan
Texas Medicaid for pregnant adults is delivered through STAR managed care plans. Your enrollment confirmation lists the plan.
Pull the plan's midwife provider directory
Search the plan's online provider directory for "midwife" or "nurse-midwife." Note the provider names that come up; treat the list as a starting point, not a final answer.
Cross-reference with state midwife directories
The Association of Texas Midwives and Home Birth Partners both list practicing midwives by city. Call practices directly: "Are you accepting Medicaid clients for [your STAR plan name] in 2026?"
Start at 12 weeks at the latest
Texas Medicaid-accepting midwives often have limited capacity. Earlier outreach gives you more options before practices close their pregnancy panels for your due date.
What if your STAR plan can't find you a Medicaid-accepting midwife?
If you've called the practices in your STAR plan's directory and none can take you, three escalation paths exist:
Switch STAR plans. Texas Medicaid lets you change your STAR plan once per 90 days. If another plan in your service area has more midwives in-network, switch.
File a network adequacy grievance. STAR plans are required to provide timely access to covered services. If the plan has no available LM/DM/CNM within reasonable distance, file a grievance and the plan is obligated to find or contract one.
Use the hospital backup option. Even if you can't find a Medicaid midwife for the birth itself, your STAR plan covers hospital delivery in full. Some Texas families pay private-pay for an out-of-hospital midwife and rely on Medicaid for prenatal care and any transfer to hospital.
Bottom line: Texas Medicaid covers home birth attended by enrolled CNMs and Documented Midwives. [1] The legal coverage exists; the practical limitation is the country's lowest Medicaid reimbursement rate, which keeps many midwives from accepting Medicaid clients. [2] Apply for STAR Medicaid as early as possible, call midwives directly rather than relying on plan directories, and consider hybrid arrangements if no fully-enrolled midwife has capacity for your due date.
- Texas Administrative Code, Title 1, Part 15, Chapter 354, Subchapter A, Division 16, § 354.1251. Midwife Services Benefits and Limitations. View source
- American College of Nurse-Midwives. Reimbursement Equity: State-by-State Medicaid Rates. View source
- KERA News. Medicaid covers half of all births in Texas. Finding quality health care can be a nightmare. February 14, 2023. View source
- Social Security Act § 1905(a)(17), 42 U.S.C. § 1396d(a)(17). Mandatory Medicaid coverage of nurse-midwife services. 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].