Medicaid Now Covers Doula Care & has Increased Payments to Certified Nurse Midwives
Medicaid Will No Longer Pay for Non-Medically Necessary Early Elective Deliveries
TRENTON – As part of the Murphy Administration’s continued effort to improve maternal and infant health, First Lady Tammy Murphy and Human Services Acting Commissioner Sarah Adelman today announced the state Medicaid program now covers doula care, while also no longer paying for non-medical early elective deliveries. Also, the Medicaid program will require obstetrical providers, nurse midwives, or other licensed health care professionals to complete a perinatal risk assessment form during a beneficiary’s first prenatal visit to help identify trends in risk factors. These initiatives are outlined in the First Lady’s Nurture NJ Maternal and Infant Health Strategic Plan, which aims to the combat New Jersey’s maternal and infant health mortality crisis by eliminating racial disparities in maternal and infant care.
“These efforts are critical to transforming a system that has historically failed our mothers and babies of color,” said First Lady Tammy Murphy. “New Jersey is turning the page to a future where every family gets off to a healthy start. Together with our statewide partners -- and with our collective and persistent commitment -- we will make New Jersey the safest and most equitable place in the nation to give birth and raise a baby.”
“With these critical steps forward, we continue making strides toward improving maternal and infant health in New Jersey,” said New Jersey Department of Human Services Acting Commissioner Sarah Adelman. “This is about positive outcomes for mothers and babies – and a healthier New Jersey for everyone. Doulas support healthy pregnancies, and by not paying for non-medical early elective deliveries, Medicaid is promoting healthier deliveries. This is more progress in our fight to improve care for women and children throughout our state.”
The new doula coverage stems from a law signed by Governor Murphy in 2019 that allows doulas to enroll as Medicaid providers and receive reimbursement for care services. A doula is a trained professional who provides continuous physical, emotional, and informational support to the birthing parent throughout the perinatal period. Research shows doula care is associated with better birth outcomes, including reductions in cesarean section rates.
Additionally, Medicaid will increase the Certified Nurse Midwife rate to be equivalent to 95 percent of the current physician rate for prenatal, labor and delivery, and postpartum services. This investment in midwifery care is good for moms and babies, and helps build a larger network of midwives in New Jersey.
The new prohibition on Medicaid paying for non-medically necessary early elective deliveries, or EEDs, also stems from a 2019 state law. EEDs are scheduled cesarean sections or medical inductions performed before 39 weeks of gestation without medical indication. Across New Jersey, hospitals, physicians and public health advocates have worked hard to reduce non-medical EED rates in recent years through education and new scheduling policies, and this new Medicaid payment policy reinforces these efforts to ensure that maternal and child health is the primary factor considered when planning a birth. Studies show non-medically necessary early elective deliveries performed before 39 weeks of gestation carry risks for babies and mothers, including higher incidences of neonatal intensive care unit admissions, pneumonia and longer hospital stays for infants. Unsuccessful inductions may also result in a cesarean section, which can lead to infections, bleeding and anesthesia complications for mothers. This initiative will not affect mothers who have medical reasons for early delivery.
The Perinatal Risk Assessment (PRA) Form is a uniform assessment tool used to determine factors considered in the risk management of a pregnant woman. The form is the uniform assessment tool for New Jersey, and as of January 1 – also under a 2019 state law – obstetrical providers, nurse midwives or other licensed health care professional approved as a provider under Medicaid will be required to complete the First Visit PRA Plus form during a beneficiary’s first prenatal visit. The data will be analyzed to identify trends in the risk factors associated with Medicaid beneficiaries during pregnancy.
The new coverage and requirements were effective January 1, 2021.
New Jersey’s Medicaid program, known as NJ FamilyCare, serves about 1.9 million New Jerseyans. Eligibility is based on income and household size. Residents may enroll year-round.
“I urge residents to visit njfamilycare.org to learn more about accessing free or affordable health care coverage,” said Human Services Assistant Commissioner Jennifer Langer Jacobs, who oversees the Medicaid program. “We offer a wide range of services, and the entire application process can be completed online.”
The First Lady unveiled the Nurture NJ Maternal and Infant Health Strategic Plan – a strategy to reduce New Jersey’s high rates of maternal and infant mortality and eliminate the racial disparities responsible for these deaths. The strategic plan is the latest element of the First Lady’s Nurture NJ initiative, which aims to make New Jersey the safest and most equitable place in the nation to deliver and raise a baby. The Nurture NJ Maternal and Infant Health Strategic Plan includes over 70 specific, actionable recommendations for maternal health stakeholders across all sectors. Funded by The Nicholson Foundation and the Community Health Acceleration Partnership, the plan will position New Jersey as a national leader in the fight for maternal health equity. For more information on Nurture NJ and the Maternal and Infant Health Strategic Plan, click here.
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