Insurance and Medicaid Prenatal Care Offerings

Part
01
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Part
01

New York Medicaid Managed Care: Prenatal/Delivery

New York State's Medicaid Managed Care programs include birth control and emergency contraception, pregnancy tests, sterilization, testing and treatment for STDs and STIs, HIV testing and counseling, pap smears, and abortions. Additional programs listed as part of the New York State's Medicaid Managed Care includes the Medicaid Family Planning, Integrated Care for Dual-Eligible Members, Community-First Choice Option Program, Doula Program, and the New York Medicaid Electronic Health Records (EHR) Incentive Program.

NEW YORK STATE'S MEDICAID MANAGED CARE

Programs

  • Members of New York State's Medicaid Managed Care program are entitled to a variety of family planning services both in- and outside their health plan. These services include birth control and emergency contraception, pregnancy tests, sterilization, testing and treatment for STDs and STIs, HIV testing and counseling, pap smears, and abortions.
  • The Department of Health recently expanded New York State's Medicaid programs to cover doula services for members of the state's Medicaid Managed Care program. The program launched in March 2019. The goal of this program is to help reduce maternal and infant death statistics, which are shown to occur at some of the highest rates in Erie and Kings Counties.
  • Medicaid Family Planning Program involves all types of birth control, emergency contraception, pregnancy tests, sterilization, testing and treatment for sexually transmitted diseases, HIV testing, pap smears; testing for cervical cancer, pelvic problems, breast disease, anemia, and high blood pressure, and abortion.
  • Integrated Care for New York's Dual-Eligible Members has been introduced as a pilot program in 2019 and includes involvement in two different programs of insurance.
  • Community-First Choice Option program provides "additional federal money to expand home and community–based services and supports to individuals in need of long term care for help with everyday activities and health–related tasks that can be performed by an aide or direct care worker."
  • New York Medicaid Electronic Health Records (EHR) Incentive Program involves "improving interoperability and patients access to health information" which covers both prenatal, delivery, and postpartum offerings.

Offerings

  • Postpartum services offerings include any "medical, dental, psychosocial (including depression), nutritional (including breastfeeding), tobacco/smoking cessation needs, alcohol and drug treatment needs of the mother or infant."
  • Prenatal Care Services offerings include Prenatal diagnostic and treatment services such as the Comprehensive assessment, Standard and special laboratory tests, Follow-up, evaluation of results and referral, HIV services, dental care, Immunizations, Lead Poisoning Prevention, Testing and Management, Ultrasounds, Screening for Genetic Disorders, and Fetal Well- Being offerings.
  • Development of a Care Plan and Care Coordination offerings includes the coordination of labor and delivery services, as well as postpartum home visitation care.
  • Health Education offerings include lessons on Rights and responsibilities of the pregnant woman, Signs and symptoms of complications of pregnancy, Physical activity, Avoidance of harmful behaviors, Sexuality during pregnancy, Occupational and environmental concerns including lead exposure, Risks of HIV infection and risk reduction behaviors, Signs of labor, Labor and delivery process and availability of various delivery options, Relaxation techniques in labor, Obstetrical anesthesia and analgesia, Preparation for parenting, Newborn screening program, and Family planning and optimum inter-pregnancy interval.
  • Nutritional offerings include Screening, Counseling and Referral for Care, mainly focused on individual nutritional risk assessment.
  • Psychosocial Risk Assessment offerings include Tobacco Use-Prenatal care assessments, Substance Use-Prenatal care assessments, Domestic Violence-Prenatal care assessments, and Depression-Prenatal care assessments.

Regulations

  • New York State's Medicaid program follow's the state's guidelines concerning prenatal care.
  • Medicaid Prenatal Care Standards are based on the following: Literature review and comparison of Part 85.40 with current ACOG guidelines and other evidence-based literature, and revisions to Article 25, New York State Public Health Law.
  • The overall guidelines have to be in line with the guidelines enacted by the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG).
  • The regulations are split into General Requirements, Provider/Staff Requirements, and Provider/Specialist/Consultation Requirements.
  • The regulations are divided into the following categories: Access to Care; Prenatal Risk Assessment, Screening and Referral for Care; Psychosocial Risk Assessment, Screening, Counseling And Referral For Care; Nutritional Screening, Counseling and Referral for Care; Health Education; Prenatal Care Services; and Postpartum Services.
Part
02
of three
Part
02

Required Prenatal/Delivery Benefits

After an extensive search through government websites, New York Health Insurance companies website, and credible media reports, we were able to locate some benefit of prenatal and delivery care required by affordable care act commercial insurers in the state of New York. Hospitalization, nurse managing in high-risk pregnancies, and parenting classes are some additional benefits offered by NY private insurers. Continue below for a deep dive into our findings.

PRENATAL AND DELIVERY CARE BENEFITS REQUIRED BY ACA COMMERCIAL INSURERS

1) Overall information

2) Preventive Care Prenatal and Delivery Benefits Commercial insurers must offer

3) New York Commercial insurers:

  • Affinity Health Plan, Capital District Physician's Health Plan, Crystal Run Health Plan, EmblemHealth, Empire Blue Cross Blue Shield, Excellus Blue Cross Blue Shield, Fidelis Care, Healthfirst New York, Oxford Health Plans, and Univera Healthcare are some private health insurance companies currently operating in the state of New York.

4) Differences from NY to other states:

  • All pregnant women, in the state of NY, are automatically eligible for a special enrollment period (SEP).
  • In 2016, the state of NY law made it possible for pregnant women that don't have insurance plan to enroll in commercial health care plan outside the normal enrollment period — an innovation when compared to other states legislative matters.

5) Additional benefits offered to pregnant women by commercial insurers:

  • CCDP — Capital District Physician's Health Plan — offers extra benefits, like inpatient services as hospitalization, prenatal vitamins, progesterone treatment to help prevent premature birth and childbirth/parenting classes.
  • Fidelis Care: offers the BabyCare (the pregnant women get the assistance of members during pregnancy) and case management in case of asthma, diabetes, heart disease, behavioral health, and HIV/AIDS.
  • EmblemHealth: offers Educational material about pregnancy on their website, a toll-free phone line, answered by a nurse, and a maternity nurse care manager in case of high-risk pregnancy.
Part
03
of three
Part
03

New York Prenatal/Delivery Care Decision Makers

Erin Kate Calicchia, Ryan P. Ashe, and Lindsay Cogan, PhD, are three key people involved in developing policy and implementing programs regarding prenatal/delivery care benefits for New York State Medicaid Managed Care, specifically in terms of low-income families.

Erin Kate Calicchia

Ryan P. Ashe

Lindsay Cogan, PhD

  • Lindsay Cogan, PhD, MS is the Director at the Division of Quality Measurement at the Office of Quality and Patient Safety for the NYS Department of Health.
  • Cogan is responsible for managing the Clinical Advisory Group which includes the Maternity Care Clinical Advisory Group that involves Centers for Medicare & Medicaid Services in regard to prenatal/delivery care benefit offerings, specifically in terms of low-income families.
  • Lindsay's email is lindsay.cogan@ny.gov, and her phone number is 518-373-9073.

RESEARCH METHODOLOGY

For this research, we focused on finding the key people involved in developing policy and implementing programs for New York State Medicaid Managed Care prenatal/delivery care benefit offerings, specifically in terms of low-income families. We defined key people as those that are at the Director or above level, as this is considered senior management. Additionally, we looked for specific proof of each individual being specifically involved in developing policy and implementing programs for New York State Medicaid Managed Care prenatal/delivery care benefit offerings, such as memorandums, presentations, or mentions of actions taken or resolutions delivered. The three individuals identified are all employed at the New York State Department of Health which is directly in charge of New York State Medicaid Managed Care.
Sources
Sources