Covered Services
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Medi-Cal members have the right to receive covered nurse midwife services from any Medi-Cal freestanding birth centers (FBCs) and to services provided by certified nurse midwives (CNMs) and licensed midwives (LMs) without referral or prior authorization.
Services provided by Medi-Cal participating FBCs, CNMs and LMs are a covered benefit. However, services or treatments that are specifically excluded from Medi-Cal coverage are not covered.
Certified Nurse Midwives and Licensed Midwives
The Department of Health Care Services (DHCS) authorizes CNMs and LMs as providers of all services permitted within the scope of the practitioner’s license. Both are authorized under state law to provide prenatal, intrapartum and postpartum care. This includes family planning care for the mother and immediate care for the newborn.
The table below outlines the differences between these two provider types and conditions under which they can provide care.
Midwife type | Licensing | Services |
|---|---|---|
CNM | Licensed as a registered nurse and certified as a nurse midwife by the California Board of Registered Nursing. | Permitted to “attend cases of normal childbirth” |
LM | Licensed as a midwife by the Medical Board of California. | Permitted to “attend cases of normal pregnancy and childbirth, as defined” and must adhere to a detailed set of restrictions and requirements when a patient’s condition deviates from the legal definition of normal. |
Freestanding Birth Centers
Federal law mandates coverage of freestanding birth centers (FBCs), also referred to as alternative birthing centers (ABCs), services and requires separate payments to providers administering prenatal labor and delivery or postpartum care. FBCs or ABCs are specialty clinics authorized to bill Medi-Cal for Comprehensive Perinatal Services Program (CPSP), obstetrical and delivery services. These centers must be accredited and certified with either the Commission for the Accreditation of Birthing Centers (CABC) or CPSP to provide prenatal labor and delivery, or postpartum care and other ambulatory services that are included in the plan coverage.
Primary care physicians (PCPs) may help members in obtaining FBC, ABC, CNM, and LM services by accessing the American College of Nurse Midwives' Find a Midwife website at www.midwife.org, and entering the member's geographic information. Members who do not have Internet access, or need translation services or other assistance, may call the Health Net Medi-Cal Member Services Department , Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties).
PCP and Care Management Responsibilities
Participating providers are required to inform Medi-Cal members of their right to obtain covered services from an out-of-network, non-participating certified nurse midwife (CNM) if one is not available in the network.
It is the primary care physician's (PCP's) responsibility to forward the member's medical records to the CNM within 30 days after receiving the member's request.
Health Net's Health Services staff is available to assist CNMs or PCPs if they have any concerns about members' care, including provision of timely services and referrals.