Benefit: Maternity / Family Planning Services

Definition:
Birth Centers/ Midwife Services are provided at facilities and provide obstetrical (medical care involving a woman and her baby during pregnancy, childbirth and the period shortly after birth), gynecological (medical care involving the female reproductive organs) and family planning services (see definition below).

Medicaid reimburses maternity services for:

• pre-birth family planning services;
• Gynecological services;
• Initial comprehensive and prenatal examinations;
• Labor management for beneficiaries who transfer to a hospital;
• Newborn assessment;
• Post delivery examinations;
• Post delivery recovery;
• Related pregnancy services; and
• Normal delivery.

Family planning services include educational, medical or social activities to help someone, including minors, to determine freely the number and spacing of their children, to learn about sexually transmitted diseases, and birth control.

Limits:  Birth Centers -- Medicaid reimbursement for birth center services is limited to:

• One family planning comprehensive visit, per year, per recipient;
• One ultrasound per pregnancy;
• Ten prenatal visits per recipient per pregnancy;
• Two postpartum visits, which include an examination of both mother and baby; and

Post delivery recovery at the birth center is limited to 24 hours.
Licensed Midwife Services: Medicaid reimburses –

• One visit, per day, per recipient.
• 10 prenatal visits per recipient per pregnancy
• 2 postpartum visits per recipient per pregnancy.
• Newborn assessments are limited to one per recipient.

Exceptions: None

Co-pays: Birth Center: There is a $2 beneficiary co-payment for gynecological services, per provider, per day, unless the recipient is exempt.
Licensed Midwife Services: None

Reform items that can vary: None