Appendix Table A2 provides detail on state Medicaid policies for genetic testing and counseling. Medical necessity and an indication of risk for genetic anomalies were the most frequently noted restrictions. Few states reported utilization controls or limitations. Only one state, Nebraska, does not cover any of the three services under any of its eligibility pathways, but the state noted that genetic testing is covered for the mother and baby with prior authorization after delivery. The eight states that do not provide genetic counseling services through any Medicaid pathway are Alabama, Alaska, Arizona, Idaho, Nebraska, New Mexico, West Virginia, and Wyoming.
Genetic counseling is covered in fewer states than either of the screening tests. Of the 41 responding states, 33 reported covering all three services across all eligibility pathways ( Table 5). States were questioned about their policies with respect to genetic counseling, CVS, and amniocentesis testing for pregnant women. If the results of screening tests are abnormal, genetic counseling is recommended and additional testing such as chorionic villus sampling (CVS) or amniocentesis may be needed. While these tests are effective screening tools to determine risk, they are not diagnostic. Routine prenatal care typically includes ultrasound and blood marker analysis to determine the risk of certain birth defects such as sickle cell, down syndrome, or other birth abnormalities. Table 5: State Coverage for Genetic Lab and Counseling Services
Nearly all responding states reported covering CVS and amniocentesis across all eligibility pathways available in the state, but fewer states reported covering genetic counseling service, which is generally limited to women with higher risk or for those that have a positive result in genetic screens. Prior Authorization to exceed state quantity limits (3)Īppendix Table A1 provides state detail for states’ prenatal service coverage policies. Table 4: Coverage and Utilization Controls for Prenatal Vitamins and Ultrasounds Some states impose limitations on this coverage however, such as requiring a prescription for prenatal vitamins or limits on the number of ultrasounds allowed during the course of a pregnancy. Some states impose quantity limits or require a prescription for vitamins.Īll states that responded to the survey reported that they cover prenatal vitamins and ultrasounds for pregnant women regardless of eligibility pathway ( Table 4). PRENATAL VITAMINS AND ULTRASOUND Key Finding: Prenatal Vitamins and UltrasoundĪll states cover prenatal vitamins and ultrasounds for pregnant women. 1 Routine prenatal care encompasses a variety of services, including provider counseling, assessment of fetal development, screening for genetic anomalies, prenatal vitamins that contain folic acid and other nutrients, and ultrasounds, which provide important information about the progress of the pregnancy.
Increasing the share of pregnant women who begin care in the first trimester is one of the national objectives of the federal government’s Healthy People 2020 initiative. Prenatal care services monitor the progress of a pregnancy and identify and address potential problems before they become serious for either the mother or baby. To our knowledge, OR and MN, and as of January 2021, NJ, are the only states currently covering doula services. Correction: While KY and MS responded to the survey that their states cover doula services, subsequent research has found that the states do not cover doula services.
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