Midwifery Services in Medi-Cal
Certified Nurse Midwives (CNM) and Licensed Midwives (LM) are individuals licensed to practice midwifery in California. CNMs and LMs are eligible to enroll as Medi-Cal providers with the California Department of Health Care Services (DHCS). CNM and LM 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.
- LMs may attend cases of normal pregnancy and childbirth, provide prenatal, intrapartum, and postpartum care. LMs are individuals who have been issued a license to practice midwifery by the Medical Board of California (MBC), and the scope of practice for LMs is defined by the MBC. Please note that due to the passage of Assembly Bill 1308 (Bonilla, Chapter 665, Statues of 2013), LMs no longer require physician supervision.
- CNMs are registered nurses and certified as nurse midwifes by the California Board of Registered Nursing (BRN). CNMs scope of practice is defined by the California BRN. CNMs are advanced practice registered nurses that are backed by the American College of Nurse Midwives. CNMs must graduate from a master's of higher-level nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education. CNMs must pass the national Certified Nurse-Midwife Examination though the American Midwifery Certification Board. In addition, all CNMs must hold state of California licensure. Please note that due to the passage of Senate Bill 1237 (Dodd, Chapter 88, Statutes of 2020), CNMs no longer require physician supervision.
Provider Enrollment
- Medi-Cal FFS: CNMs and LMs may enroll as Medi-Cal FFS providers through 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 Managed Care: CNMs and LMs interested in providing services to Medi-Cal managed care members who receive care through Medi-Cal MCPs will need to enter into contracts with individual Medi-Cal 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. LMs and CNMs must contact the Medi-Cal MCP directly for instructions on how to become a Medi-Cal MCP network provider.
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:
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.
