How Medicaid Programs Provide Coverage for Maternal Health Services

Most Medicaid programs offer coverage for basic maternal health services and many have initiatives planned to expand the scope of benefits, according to a report from the Kaiser Family Foundation (KFF).

Federal regulations require state Medicaid programs to cover inpatient and outpatient hospital care for low-income pregnant people, but states have the power to expand this coverage and offer additional care.

KFF and Health Management Associates (HMA) surveyed states between June 2021 and October 2021 to determine their Medicaid benefit policies for reproductive health services. Researchers gathered information on prenatal and delivery, counseling and support services, breastfeeding and postpartum visits, and future initiatives.

The report reflects data from 41 states and the District of Columbia.

All states reported covering prenatal services, including visits, ultrasounds, and vitamins. A few states used utilization controls for prenatal vitamins, such as days limits, generic requirements, and requiring inclusion on a Preferred Drug List (PDL). Additionally, some states required prior authorization or prescriptions for prenatal vitamins.

States also imposed utilization controls on ultrasounds. For example, Pennsylvania covers one ultrasound per pregnancy and Utah covers ten ultrasounds during a 12-month period. Meanwhile, Indiana and West Virginia only cover ultrasounds with a medical necessity.

Most states covered blood pressure (31 states) and glucose monitors (35 states) for home use, but a few states subjected coverage to medical necessity, while other states required prior authorization or prescriptions.

Many Medicaid programs also provided dental services for pregnant people, with 39 states offering coverage. Educational classes and group prenatal care coverage were less common, with under half of state respondents providing these services.

Twenty-five states covered home births and 35 states covered unlimited postpartum visits. Except for Rhode Island, all of the states covered postpartum depression screening, with a few states like California, Kansas, and Iowa imposing a limit on the number of covered screenings.

However, only three states (Indiana, New Jersey, and Oregon) reported covering doula services. Pregnant people who receive doula support tend to have shorter labors, fewer birth complications, and lower C-section rates, the report noted.

Maryland, Nevada, and Virginia have introduced doula coverage that will start in 2022. Meanwhile, 11 additional states reported considering adding doula services to their benefits.

More than half of the states provided breastfeeding education and lactation consultation services. Many states also covered breast pumps, but several required prior authorization.

Fertility service coverage varied among states. Eleven states covered fertility counseling outside of a well-woman visit and diagnostic testing. Four states offered coverage for fertility medication. Illinois was the sole state to cover all fertility services, including egg freezing, intrauterine insemination, and in vitro fertilization.

Most states (37 states) covered case management services for pregnant people, though several noted that coverage was limited to high-risk pregnancies, target populations, or qualifying conditions. A few states also imposed time constrictions or medical necessity determinations.

Similarly, 36 states offered coverage for prenatal and postpartum home visits, with six states requiring prior authorization or limiting coverage to high-risk individuals.

Regarding substance use disorder (SUD) coverage, federal regulation requires states to provide medication-assisted treatment (MAT), including buprenorphine and naloxone. Thirty-six states offered a larger scope of SUD benefits.

For example, 27 states offered all or some of the services recommended by the American Society of Addiction Medicine. Five states covered outpatient SUD services and ten states covered residential pediatric recovery centers.

Eight states reported plans to expand substance use disorder treatment or mental health services for pregnant people. Colorado and Maine intend to implement a maternal opioid misuse (MOM) model, while six states plan to expand home visiting benefits for higher-risk pregnancies.

More than half of the states plan to extend the length of postpartum coverage. Federal policy requires Medicaid programs to cover services through 60 days postpartum.

Massachusetts, California, and Illinois have proposed extending postpartum coverage for individuals regardless of immigration status. Washington state plans to expand coverage for people who may not qualify for Medicaid and did not receive coverage during their pregnancy. Certain states that have not expanded Medicaid under the Affordable Care Act also plan to extend postpartum coverage.