Family and Children's Medicaid MA-3540 Medicaid Covered Services

XXXV. Medicaid for Pregnant women

Selected services are allowed for pregnant women whose aid category is Medicaid for Pregnant Women (MPW).

A. Services Related to the Pregnancy

Services for MPW recipients are limited to services related to the pregnancy or for treatment of illness or injury trauma that in the physician’s judgment may complicate the pregnancy. This includes:

1. Conditions related to the pregnancy,

2. Pre-existing conditions, and/or

3. New pathological conditions that may adversely affect the best possible outcome from the pregnancy

B. Covered services

1. Prenatal Care

2. Outpatient prenatal testing

3. Inpatient hospital services

4. Labor and delivery services

5. Family planning services

6. Pharmacy services

7. Baby Love services

8. Physician services

9. Medical consultation

10. Routine dental care – covered only through the date of delivery

11. Behavior health services

REVISED 08/01/11 – CHANGE NO. 14-11

(XXXV.B)

12. Postpartum services

a. Postpartum is defined as the period of time from the last day of pregnancy through the last day of the month in which the 60th post-delivery day occurs. Services are covered for live births, miscarriages, fetal deaths, molar pregnancies, neonatal deaths, and therapeutic abortions.

b. Postpartum services include medical services needed as a result of a complication of the pregnancy or family planning services.

C. Restrictions

Pregnancy related services provided to an MPW recipient do not count toward the recipient’s professional services visit limit.

D. Copayments

There are no copayments for MPW recipients.

E. Prior Approval

1. It is the provider’s responsibility to obtain prior approval if needed. (Refer to II.G. for additional information.)

2. The following services require prior approval for MPW recipients.

a. Podiatry

b. Chiropractic services

c. Optical services, except for medical services or treatment for conjunctivitis, eye infections, eye injury, etc.

d. Durable medical equipment

e. Home health services

f. Hospice

g. Home infusion therapy (HIT)

h. Private duty nursing (PDN)

REVISED 08/01/11 – CHANGE NO. 14-11

For questions or clarification on any of the policy contained in these manuals, please contact your local county office.