Care Management services are provided for pregnant Medicaid recipients who are determined to be at risk for poor birth outcome. All patients identified as having priority risk factors will be assessed by a pregnancy care manager. Priority risk factors include: A history of preterm birth, a history of low birth weight, multiple gestation, fetal complications, chronic conditions which may complicate pregnancy, unsafe living environment (homelessness, inadequate housing, violence or abuse), substance use, tobacco use, missing two or more prenatal appointments without rescheduling, and inappropriate hospital utilization, All Pregnancy Medical Home (PMH) providers are required to complete a pregnancy risk screening to identify these and other risk factors. Non-PMH providers will also be able to refer their patients for Pregnancy Care Management services.
The overall model seeks to improve birth outcomes, which will be measured by NICU length of stay, infant medical care costs in the first year of life, gestational age at delivery, rates of low birth weight and very low birth weight, and the primary cesarean section rate.
No one will be denied services based on inability to pay and discounts are available based on family size and income.