Medicaid as a workforce tool

A new National Academy for State Health Policy review says every state Medicaid program pays certified nurse-midwives, but the rules still vary enough to shape where they can actually practice. (nashp.org) The April 14, 2026 brief says certified nurse-midwife services are a mandatory Medicaid benefit and are reimbursed in all 50 states and Washington, D.C. It tracks differences in payment rates, covered services, scope-of-practice rules, and which care settings qualify for payment. (nashp.org) Most states still peg certified nurse-midwife payment to a share of the physician rate for the same service. In 2025, 29 states and Washington, D.C., paid 100 percent of the physician rate for a vaginal delivery, up from 25 states and Washington, D.C., in 2023. (nashp.org) Medicaid is not a niche payer in maternity care. Kaiser Family Foundation data show Medicaid financed 1,479,782 births in 2023, or 41 percent of all U.S. births. (kff.org) That makes payment policy a workforce policy. The National Academy for State Health Policy says states are using Medicaid coverage of certified nurse-midwives as part of broader efforts to strengthen the perinatal workforce and expand access to maternity care. (nashp.org) The access problem is geographic as well as financial. March of Dimes reported in 2024 that 35.1 percent of U.S. counties were maternity care deserts, with no birthing facility or obstetric clinician. (marchofdimes.org) Federal law requires states to cover nurse-midwife services, but states still control how those benefits work in practice. Medicaid says states determine the type, amount, duration, and scope of services within broad federal guidelines, and federal regulations list nurse-midwife service among required benefits. (medicaid.gov) (law.cornell.edu) The federal rules also say a nurse-midwife must be allowed to enter an independent Medicaid provider agreement without being tied to a physician. The National Academy for State Health Policy review says state licensing and place-of-service rules still affect whether that independence translates into billable care on the ground. (law.cornell.edu) (nashp.org) The policy fight sits inside a larger maternal health debate. The Medicaid and CHIP Payment and Access Commission said midwifery-led care has been linked to lower cesarean rates, fewer preterm births and low-birthweight babies, and lower overall Medicaid costs, even though 90 percent of Medicaid-financed births are still attended by doctors and 99 percent still occur in hospitals. (macpac.gov) The National Academy for State Health Policy’s map turns a billing question into a staffing map: if Medicaid pays less, limits settings, or narrows practice rules, a covered provider can still be missing where pregnant patients need care. (nashp.org)