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
- 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.
- 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.
- 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.