The Medicaid Prenatal Plus Program seeks to improve the health of at-risk mothers to improve the well-being of the mother and the child.
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Program Overview
The purpose of the Prenatal Plus Program (PPP) is to reduce the incidence of low birth weight, pre-term birth, and adverse birth outcomes while also addressing other lifestyle, behavioral, and nonmedical aspects of an at-risk mother's life that may affect the health and well-being of the mother or the child.
Eligibility Criteria
The eligible population for the PPP is an at-risk mother, defined as an individual who is:
- Enrolled in Medicaid
- Pregnant
- Determined by her healthcare provider to be at risk of having a negative maternal or infant health outcome
Individuals in the 599 CHIP category are not eligible for the Prenatal Plus Program.
Program Services
There are 5 services eligible for reimbursement under PPP:
- TCM is the initial comprehensive and periodic assessment of the pregnant mother's needs, development of the care plan that specifies the goals and actions, referrals for linkage to clinical and non-clinical services, monitoring, and follow-up activities to ensure the care plan is implemented.
- TCM includes educating the pregnant individual, providing resources, scheduling referrals, addressing barriers to ongoing care, and engaging family members or other clinicians and entities as indicated.
- Nutrition Counseling includes personalized nutritional guidance to the pregnant individual through supportive one-on-one counseling.
- Nutrition Counseling is provided by the prenatal clinician as part of routine prenatal care. The pregnant individual can also be referred to a Licensed Medical Nutrition Therapist.
- PPP covers up to 6 sessions of Nutrition Counseling when provided by a Licensed Medical Nutrition Therapist, which can be provided in-person or via audiovisual telehealth.
- The pregnant individual can be referred to a Licensed Mental Health Provider.
- There is no limit on the number of mental health and substance use disorder (SUD) services a pregnant individual can receive and is based on medical necessity.
- Breastfeeding Support includes general education, help in acquiring a breast pump, and contact information for lactation counseling after the birth.
- The pregnant individual can be referred to a Breastfeeding Instruction Session.
- Breastfeeding Instruction Sessions can be provided by a Licensed Medical Nutrition Therapist or International Board-Certified Lactation Consultant (IBCLC), in-person or by audiovisual telehealth and in an individual or group setting.
- A variety of education topics are provided to the pregnant individual that cover the prenatal period, childbirth, breastfeeding, postpartum period, and healthy infancy.