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Maternity Benefits and Member Supports

Sunshine Health cares about the health and safety of new mothers and babies. We offer an array of benefits and resources to support members from pregnancy to birth and beyond.

Providers can play a key role in reducing maternal mortality by listening to women’s concerns before, during and after pregnancy. Providers should recognize the physical and mental signs that patients need care and train new mothers to monitor their own health and recognize when they should seek help. The Centers for Disease Control and Prevention offers tips for addressing maternal mortality:

  • Watch out for chronic conditions that can arise during pregnancy, such as diabetes, depression and hypertension. According to the CDC, 31% of maternal deaths occur during pregnancy, 36% during labor and delivery and 33% up to a year after birth.
  • During well-child visits at 1, 2, 4, and 6 months of age, providers should also screen the mother for postpartum depression. New mothers may also ignore their own health risks, so educate them.
  • Listen to patients and respect their concerns.

 

Community Connections Team

Sunshine Health Member Services

Children's Medical Services (CMS) Health Plan

 

Standard Benefits

  • OBGYN visits (no limit).
  • Reproductive services for members who are pregnant or trying to become pregnant.
  • Confidential family planning services without prior approval for ages 18 years and under.
  • Primary care physician visits for mother and child (no limit).

 

Medicaid Expanded Maternal/Child Benefits

 For Sunshine Health Medicaid (MMA), Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP), Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI) Plan and Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV) Members

  • Biometric Equipment
  • Camp scholarship
  • Caregiver swimming lessons
  • Care grant
  • Cellular services
  • Childcare
  • Circumcision (newborns)
  • Dental kit
  • Doula services (unlimited)
  • Expanded prenatal services
    • Unlimited prenatal and postpartum provider visits
    • Access to breast pumps
  • Home delivered meals for pregnant members*
  • Non-emergency medical transportation
  • Nutritional counseling*
  • Over-The-Counter (OTC) baby supplies
  • Swimming lessons for children
  • Welcome Baby! Bundle
  • YMCA membership

* Prior authorization required.

 

Children’s Health Plan (CMS) Health Plan Expanded Maternal/Child Benefits

  • Biometric Equipment
  • Circumcision (newborns)
  • Doula services (unlimited)
  • Expanded prenatal services
    • Unlimited prenatal and postpartum provider visits
    • Access to breast pumps
  • Non-emergency medical transportation
  • Nutritional counseling
  • Over-The-Counter (OTC) baby supplies
  • Swimming lessons for children
  • Wellness Benefits

 

Special Programs

  • $50 NOP Incentive: Providers eligible for a $50 incentive for each Notice of Pregnancy form sent to our Secure Provider Portal within 30 days of a member’s first prenatal visit.
  • Doula support: Pregnant members receive unlimited doula visits, in-person labor support and 24/7 on-call support for 37 weeks until birth. Prior authorization is not required. Find a doula through The Doula Network or Sunshine Health’s Find a Provider tool.
  • First Year of Life Program: Sunshine Health program dedicated to supporting mothers and their babes during their first 15 months in areas such as health, nutrition, vaccines, home safety and regular visits to the child’s primary care provider.
  • Nurse-Family Partnership®: Families develop a close relationship with a nurse who advises and supports them through a healthy pregnancy to raising a healthy child.
  • Optum: Provides support, education and resources to improve neonatal health outcomes for preterm births and newborns admitted into the Neonatal Intensive Care Unit (NICU).
  • Start Smart for Your Baby®: Provides support and care for pregnant women and new moms, including help with housing, food, clothing, cribs and access to licensed medical staff if any issues occur during pregnancy.
  • WIC: Women, Infants and Children is a supplemental food and nutrition program for families 

 

Mental Health Special Programs

Brave Health: Virtual mental health services; members must be 13 years of age and up.

LunaJoy: Live, virtual, holistic mental health counseling for women through every phase of their lives with an emphasis on maternal mental health.

Teladoc Health: Virtual healthcare available to members of all ages.

Teladoc Health App: A mobile app that offers resources and support for addressing stress, depression, sleep issues and other conditions tailored to each member’s individual needs.

 

Substance Abuse Special Programs

  • HALO: The Health Assistance, Linkage & Outreach program uses evidence-based care and a predictive model to treat members with an opioid use disorder.
  • Puff-Free Pregnancy: Pregnant members who complete four Tobacco Cessation Health Coaching Sessions within 6 months of the first year are eligible for a $5 reward for each completed session.

 

Additional Resources

Baby Navigator: Baby Navigator’s mission is to provide resources and tools for families to celebrate and support their baby’s early learning and to nurture the development of language and success in school. The website provides new parents with resources to understand early social commination milestones; the 16 Early Signs of Autism by 16 Months Lookbook to identify the condition early; and educational courses and tools for parents of children diagnosed with autism through the Autism Navigator.

HEAR HER® Campaign: This CDC program aims to reduce pregnancy-related deaths by educating the public about pregnancy-related complications and encouraging a pregnant member’s support system to listen to their health concerns and act appropriately.

The Period of PURPLE Crying: The National Center on Shaken Baby Syndrome’s program to prevent shaken baby syndrome/abusive head trauma. Members can learn about early increased infant crying and access videos, a PDF booklet and an app:

 

Healthy Rewards

For Sunshine Health Medicaid (MMA) , Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI) Plan and Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV) Members

Amount

Activity

Description

$20

Notification of Pregnancy (NOP) Form (First Trimester)

Sign completed NOP form within first trimester 

$10

NOP Form (Second Trimester)

Sign completed NOP form within second trimester 

$50

Prenatal Visits

Complete 3 prenatal visits

$20 per year ($5 per session)

Puff-Free Pregnancy

 

Complete 4 tobacco cessation coaching sessions within 6 months of the first; $5 reward for each session

$20

Tdap Vaccine for Pregnant Women

Receive Tdap (tetanus, diphtheria, pertussis) vaccine during pregnancy

$40

Postpartum Visit

Complete postpartum follow-up visit 7-84 days after delivery

$30

Annual Well Child Visit Ages 0-21 Years

One visit per calendar year with Primary Care Provider (PCP)

$20

Lead Screening, Children under Age 2 Years

One reward per child, per year, up to 2 years of age

 

Sunshine Health Pathway to Shine Specialty Plan (CWSP) Members

Amount

Activity

Description

$20

Notification of Pregnancy (NOP) Form (First Trimester)

Sign completed NOP form within first trimester 

$50

Prenatal Visits

Complete 3 prenatal visits

$20 per year ($5 per session)

Puff-Free Pregnancy

 

Complete 4 tobacco cessation coaching sessions within 6 months of the first; $5 reward for each session

$20

Tdap Vaccine for Pregnant Women

Receive Tdap (tetanus, diphtheria, pertussis) vaccine during pregnancy

$40

Postpartum Visit

Complete postpartum follow-up visit 7-84 days after delivery

$20

Lead Screening, Children under Age 2 Years

One reward per child, per year, up to 2 years of age

Children’s Medical Services (CMS) Health Plan Members

Amount

Activity

Description

$20

Notification of Pregnancy (NOP) Form (First Trimester)

Sign completed NOP form within first trimester 

$50

Prenatal Visits

Complete 3 prenatal visits

$20 per year ($5 per session)

Puff-Free Pregnancy

 

Complete 4 tobacco cessation coaching sessions within 6 months of the first; $5 reward for each session

$20

Tdap Vaccine for Pregnant Women

Receive Tdap (tetanus, diphtheria, pertussis) vaccine during pregnancy

$20

Postpartum Visit

Complete postpartum follow-up visit 7-84 days after delivery

$10

Annual Well Child Visit 0-30 Months

One visit per calendar year with Primary Care Provider (PCP)

$20

Annual Well Child Visit Ages 3-21 Years

One visit per calendar year with PCP

$20

Lead Screening, Children under Age 2 Years

One reward per child, per year, up to 2 years of age