Midwifery Services in Medi-Cal
California currently recognizes two kinds of midwives: Certified Nurse Midwives (CNM) who are sometimes referred to as Nurse Midwives (NMW) and Licensed Midwives (LM). Both LMs and CNMs can practice independently, they do not require physician supervision and are Eligible to enroll as Medi-Cal providers with the California Department of Health Care Services (DHCS). CNMs and LMs who are enrolled in Medi-Cal may provide Medi-Cal covered benefits and services within their applicable scopes of practice in both the fee-for-service (FFS) and through managed care plans (MCPs) in the managed care delivery systems.
Nurse-Midwives (CNM)
How to Become a Medi-Cal Midwife Provider
The majority of California's Medi-Cal pregnant enrollees are cared for through Managed Care Plans (MCP) a smaller number are cared for through fee for service (FFS). Midwives (CNMs and LMs) may enroll through the Provider Application and Validation for Enrollment (PAVE) portal to submit their Medi-Cal application to provide care for to people through both FFS and MCP.
Midwives (CNMs and LMs) interested in serving Medi-Cal managed care plan (MCP) members will also need to enter contracts with the member's Medi-Cal MCP plan. LMs and CCNMs must contact the Medi-Cal MCP directly for instructions on how to become a Medi-Cal MCP network provider.
Medi-Cal Fee For Service (FFS):
Enrollment in Medi-Cal through PAVE is all that is required to start taking Medi-Cal FFS. DHCS pays out directly at rates set by the State for care provided to individuals covered by FFS. Current Rates can be found here.
Medi-Cal Managed Care:
CNMs and LMs interested in providing services to Medi-Cal managed care members who receive care through Medi-Cal MCPs must first enroll with Medi-Cal through PAVE. After enrolling with PAVE they must contract directly with the MCPs. Only CNMs and LMs who entered into contracts with Medi-Cal MCPs will be able to receive reimbursement for services provided to MCP members. To view a list of Medi-Cal MCPs in your county, please visit DHCS' Medi-Cal Managed Care Health Plan Directory website.
DHCS' Provider Application and Validation for Enrollment (PAVE) portal
For more information about PAVE, please visit DHCS' PAVE Provider Portal (ca.gov) website. You may also call the PAVE Help Desk at (866) 252-1949, and one of DHCS' experts will be happy to assist you (available Monday – Friday, 8:00 am – 6:00 pm Pacific time, excluding state holidays).
Medi-Cal Provider Manuals
Medi-Cal coverage policy for both Medi-Cal FFS and managed care delivery systems as well as Medi-Cal FFS reimbursement policy can be found in the Medi-Cal Provider Manual. Medi-Cal covered benefits and services provided by CNMs and LMs within their respective scopes of practice can be found in several different sections of the Medi-Cal Provider Manual, including:
- Non-Physician Medical Practitioners (NMP) Manual: This manual includes billing guidance for LM and CNMs and information about care covered by Medi-Cal. Additional Resources and information can be found in the following subsections of the the Medi-Cal provider manual:
All Plan Letters (APL)
Medi-Cal managed care communicates with Medi-Cal MCPs by means of APLs, which convey information or interpretation of changes in policy or procedure at the federal and/or state levels, and provides instruction to contractors, if applicable on how to implement these changes on an operational basis. Information for CNMs and LMs can be found in several different APLs, including:
Medi-Cal Trainings
The Medi-Cal Learning Portal offers Medi-Cal providers, including CNMs and LMs, and billers self-paced online trainings about billing basics, policies, procedures, new initiatives, and upcoming changes to Medi-Cal.
The following are suggested trainings for CNM and LMs:
- Basic Billing: This training series focuses on Medi-Cal Billing Basics including Recipient Eligibility, Share of Cost, Treatment Authorization Request (TAR), CMS-1500 or UB-04 Claim Completions and Claims Follow-Up.
- CPSP Recorded Webinar: This module will familiarize participants with the wide range of services available to pregnant Medi-Cal recipients enrolled in CPSP from the date of conception through 60 days after the month of delivery. Recipient and provider participation is voluntary. Billing information is also covered.
Resources
The following are additional resources that CNMs and LMs may find helpful:
Contact Us
If CNMs and LMs have additional questions, they can contact DHCS for further assistance, as follows:
- For billing and claim submission questions, please contact DHCS' Fiscal Intermediary via phone through the Telephone Service Center (TSC) at 1-800-541-5555. For faster access to TSC resources, refer to the TSC Main Menu Prompt Options Guide.
- For policy guidance, please send an email to Medi-Cal.Benefits@dhcs.ca.gov.
