States reported using utilization controls to manage the benefit for prenatal vitamins such as days limits, generic requirements, and inclusion on a Preferred Drug List (PDL) (Table 1).

The majority of states reported that coverage for prenatal vitamins and ultrasounds aligned across coverage eligibility groups, with exception of Oklahoma (for prenatal vitamins) and Utah and Mississippi (for ultrasounds). While states are not required to cover over-the-counter drugs, they must cover nonprescription prenatal vitamins. Prenatal Vitamins and UltrasoundsĪll responding states reported covering prenatal vitamins and ultrasounds for pregnant people, but some states impose utilization controls. Access to routine prenatal care provides an opportunity to identify any problems with the pregnancy early on and is associated with lower rates of some pregnancy-related complications. Routine prenatal care encompasses a variety of services, including provider counseling, assessment of fetal development, screening for genetic anomalies, prenatal vitamins that contain folic acid and other nutrients, and ultrasounds, which provide important information about the progress of the pregnancy. Increasing the share of pregnant women who begin care in the first trimester is one of the national objectives of the federal government’s Healthy People 2030 initiative. Prenatal care services monitor the progress of a pregnancy and identify and address potential problems before they become serious for either the mother or baby. This report presents detailed survey findings from 41 states and DC on fee-for-service coverage and utilization limits for Prenatal care and Delivery, Fertility Services, Counseling and Support Services, Substance Use Disorder Services, and Breastfeeding Supports and Postpartum Care. Bundled payments, however, also make it more difficult to track the delivery of component services that may be included in the bundle, such as health education or counseling.

This kind of payment for an episode of care can help states manage costs and also provide incentives for coordination of comprehensive care across maternity providers. For example, maternity care is often reimbursed as a bundled payment that covers all professional services provided during the perinatal period, including prenatal care, labor and delivery, and postpartum care, and a separate facility fee. In addition to benefits, states also have discretion regarding reimbursement methodologies which also affect beneficiaries’ access to maternity care services. This survey’s questions focused on state Medicaid policies and coverage under fee-for-service, and these policies typically form the basis of coverage for MCOs. A majority of states contract with managed care organizations (MCOs) under a capitated structure to deliver Medicaid services, and plans may vary in their coverage of specific services. While states can vary in the benefits they provide to some pregnant individuals depending on their eligibility status, the vast majority of states provide the full Medicaid package to all pregnant beneficiaries. The range of pregnancy-related services that states cover is shaped by many factors, and states have significant latitude to set income eligibility levels, define specific maternity care services, and apply utilization controls such as prior authorization and preferred drug lists (PDL).

This survey asked states about the specific maternity services they cover. Medicaid covers more than four in ten births nationally and the majority of births in several states.

Kaiser harmony test