Does Medicaid Cover Midwives in Texas?
Navigate Texas Medicaid's coverage for midwifery care. Understand if services are covered and how to access qualified providers.
Medicaid is a joint federal and state program providing healthcare coverage to low-income individuals and families. In Texas, Medicaid helps ensure access to medical services, particularly for pregnant women. For those seeking maternity care, understanding Texas Medicaid’s coverage for midwifery services is important, as it offers an alternative approach to prenatal, labor, and postpartum care.
Medicaid Coverage for Midwifery Services in Texas
Texas Medicaid covers midwifery services, with coverage varying by midwife type and care setting. Certified Nurse-Midwives (CNMs) are registered nurses with advanced midwifery training. Their services are covered by Texas Medicaid if they are enrolled participants. CNMs can provide comprehensive prenatal care, manage labor and delivery, and offer postpartum services. Coverage applies if services are within the CNM’s defined scope of practice under state law and are services typically provided by a licensed physician.
Certified Nurse-Midwives can provide care in various settings, including hospitals and birthing centers. Home deliveries performed by a CNM are also reimbursable by Medicaid, but they require prior authorization from the Texas Health and Human Services Commission (HHSC). Prior authorization for home deliveries typically requires a written request and a physician’s confirmation that the recipient is not high-risk.
Licensed Midwives (LMs), often called direct-entry midwives, are also covered by Texas Medicaid. LM services are reimbursed if provided in a licensed freestanding birthing center approved for Texas Medicaid. Covered services include prenatal care, labor and delivery, immediate postpartum care until discharge from the birthing center, and newborn care during that same period. Licensed Midwives are required to have arrangements for referral and consultation with a physician in case of medical complications. Coverage for other midwife types, such as Certified Professional Midwives (CPMs), may be more limited under Texas Medicaid.
Accessing Midwifery Care Through Texas Medicaid
To access midwifery care through Texas Medicaid, individuals must first confirm eligibility. Pregnant individuals can apply for Medicaid for Pregnant Women online at YourTexasBenefits.com, by calling 2-1-1, mailing a paper application, or visiting a Texas Health and Human Services Commission (HHSC) benefits office or community partner. Eligibility is generally income-based, for those at or below a certain federal poverty line percentage. Medicaid for Pregnant Women provides coverage throughout pregnancy and extends for up to 12 months postpartum.
Once enrolled in Medicaid, individuals select a managed care health plan. To find a midwife accepting Texas Medicaid, beneficiaries can use provider search tools on their health plan’s website or the Texas Medicaid & Healthcare Partnership (TMHP) site. These tools allow users to search for providers within their service area. Contact the midwifery practice or birthing center directly to confirm they are accepting new Texas Medicaid clients, as provider participation can change.
Providers can verify Medicaid eligibility at appointments, even without a physical identification card. This ensures necessary services are not delayed. Care typically involves regular prenatal visits, birthing services, and postpartum follow-ups, all coordinated through the Medicaid health plan and chosen midwifery provider.