Postpartum Pelvic Floor Rehab Covered by State Medicaid Waivers
Postpartum Pelvic Floor Rehab Covered by State Medicaid Waivers
Pelvic floor rehabilitation isn’t just a buzzword among wellness influencers—it’s a medical necessity that many postpartum women never hear about until it’s too late.
And when you’re relying on Medicaid to access care, the gaps in coverage can feel enormous.
In this post, we unpack how different states are beginning to cover pelvic floor rehab under Medicaid waivers, what hurdles remain, and how moms, providers, and payers can bridge the gap.
We’ve even thrown in some personal stories, real policy links, and a few moments of "Seriously? That's the rule?" along the way.
π Table of Contents
- Why Pelvic Floor Rehab Matters After Birth
- How Medicaid Waivers Work
- State-by-State Coverage Landscape
- Who Qualifies for Coverage?
- Approved Rehab Providers
Why Pelvic Floor Rehab Matters After Birth
Would you ever think sneezing could be terrifying? For thousands of new moms dealing with stress incontinence, it absolutely is.
When Lisa, a mother of two in rural Kansas, couldn’t jump without leaking, she didn’t think it was a ‘medical dysfunction’—just ‘mom life.’
But pelvic floor issues like hers are all too common, and too often ignored.
Urinary incontinence, painful intercourse, lower back pain, and even pelvic organ prolapse—these aren’t just annoyances.
They are medical conditions, often rooted in the trauma of childbirth.
Pelvic floor rehab can dramatically reduce these symptoms, yet millions of women never access it.
How Medicaid Waivers Work
So how can public insurance step up to meet this need?
Medicaid, the federal-state insurance program for low-income individuals, typically doesn’t cover pelvic rehab out of the box.
But that’s where waivers come in—tools like Section 1115 Demonstration Waivers and Home and Community-Based Services (HCBS) Waivers.
These waivers allow states to experiment, cover non-traditional services, and extend maternal care.
Some have chosen to cover pelvic floor therapy for postpartum recovery, especially in high-need or underserved areas.
But as with most things Medicaid—it depends on where you live.
Before we get deeper into state policies, here’s something that may support your work as a provider or advocate π
State-by-State Coverage Landscape
Coverage can feel like a lottery—where you live may matter more than what you need.
As of 2025, 14 U.S. states explicitly support postpartum pelvic floor rehab under Medicaid waivers or extensions.
Here are some notable examples:
California covers pelvic PT as part of the CalAIM maternal health initiative.
New York includes it if prescribed by an OB/GYN for healing from vaginal tearing or C-sections.
Illinois includes it under the 12-month postpartum extension for Medicaid enrollees.
Meanwhile, states like Texas or Mississippi either exclude it outright or require proof of severe trauma.
There’s no national standard—meaning advocacy remains crucial.
Who Qualifies for Coverage?
Let’s say you just gave birth, you’re on Medicaid, and you're wondering if you qualify.
Most states require the following:
Enrollment in Medicaid at the time of delivery or within the postpartum extension window (60 days to 12 months).
A physician’s referral, often from your OB/GYN or midwife.
A formal diagnosis: pelvic floor dysfunction, incontinence, dyspareunia, or similar ICD-10 codes.
In some states, a physical therapist’s assessment is also required to verify loss of function.
Approved Rehab Providers
This isn’t a “go to any gym” situation.
Medicaid generally only reimburses licensed providers who are enrolled in the state’s network.
These typically include:
Physical Therapists (PT or DPT) with pelvic health certification
Occupational Therapists experienced in postpartum care
Midwives or nurses trained in pelvic rehab (in some states)
Some forward-thinking states are piloting telehealth partnerships for rural postpartum rehab, often through secure video platforms or mobile clinics.
To be continued in Part 2: Reimbursement Codes, Loopholes, and What the Future Holds
Medicaid Waiver, Pelvic Floor Rehab, Postpartum Therapy, Maternal Health, Insurance Coverage
Reimbursement and CPT Codes
Here’s where things get really bureaucratic—but stay with us.
To get reimbursed for pelvic floor therapy through Medicaid, providers must use proper CPT (Current Procedural Terminology) codes during claim submission.
Some of the most commonly accepted codes include:
97110: Therapeutic exercises, 1-on-1, 15 minutes
97112: Neuromuscular re-education—used frequently in pelvic floor work
97530: Therapeutic activities to improve function
Some states require these to be tied to postpartum-specific ICD-10 diagnosis codes such as:
O70.1: Second-degree perineal laceration during delivery
R32: Unspecified urinary incontinence
N81.1: Cystocele or prolapse
Incorrect code usage is one of the top reasons for claim denials. Many PT clinics have started hiring billing specialists just to manage Medicaid postpartum claims.
Barriers and Legal Loopholes
Even with the codes in place, several barriers persist:
Some Medicaid managed care plans limit rehab to 20 sessions/year—not nearly enough for trauma recovery.
Patients must often drive hours to find a credentialed pelvic health PT who accepts Medicaid.
Telehealth may be reimbursed only if the platform is HIPAA-compliant and pre-approved by the Medicaid administrator.
Then there’s the documentation monster. Some states still require hand-signed paper referrals from OB/GYNs, which slows down access.
And let’s not even start on the issue of “medically necessary”—a term that Medicaid interprets differently than most clinicians.
One therapist in Georgia described having 80% of postpartum claims denied for “insufficient justification,” despite physician referrals and positive outcomes.
The Future of Equitable Coverage
Things are improving—but not fast enough.
Advocacy groups like Postpartum Support International and The Pelvic Health Foundation are lobbying state governments to classify pelvic rehab as essential maternal care.
CMS (Centers for Medicare & Medicaid Services) has also hinted at future guidance encouraging coverage consistency across states.
Technology may also help: AI-based intake forms can accelerate referral and documentation flows for Medicaid cases.
What we need now is policy standardization, maternal equity funding, and streamlined provider credentialing.
Because sneezing shouldn’t be scary for moms.
π Helpful External Resources
Bottom line: If you’re a new mom on Medicaid, don’t assume you’re on your own. Coverage may be there—you just need the right codes, the right provider, and a little help navigating the system.
And if you’re a provider, billing admin, or maternal health advocate—let’s push for better clarity, stronger waivers, and equity in access.
Postpartum Rehab, Medicaid Waiver, Pelvic Floor Therapy, Reimbursement Codes, Maternal Care Access