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% in the 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, respect their concerns and recognize any potential biases that could affect quality of care. Black, American Indian and Alaska Native women have a higher risk of dying from pregnancy-related complications.

 

Community Connections Team

Sunshine Health Member Services

Children's Medical Services (CMS) Health Plan

 

Standard Benefits

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

 

Expanded Maternal/Child Benefits

  • Biometric Equipment
  • Care grant (for CW specifically)
  • Cell phone
  • Chiropractic services
  • Circumcision (newborns)
  • Doula services (unlimited)
  • Flu prevention kit
  • Home delivered meals*
  • Massage therapy*
  • Non-emergency medical transportation
  • Nutritional counseling*
  • Over-The-Counter baby supplies
  • Swimming lessons

* Prior authorization required.

 

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.
  • Mom's Meals®: A 12-month meal delivery program for high-risk maternity members with gestational diabetes, hypertension and preterm labor to improve birth outcomes.
  • 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 that also offers referrals to healthcare, immunizations and community services.

 

Mental Health Special Programs

  • Brave Health: Telehealth mental health care offering counseling, therapy, psychiatry and medication-assisted treatment. Note: For enrollees ages 13 years and older.
  • LunaJoy: Live, virtual, holistic mental health counseling for women through every phase of their lives with an emphasis on maternal mental health.

 

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 4 Tobacco Cessation Health Coaching Sessions within 6 months of the first are eligible for a $5 reward for each completed session.
  • StrongWell: Helps expecting and new mothers with anxiety, depression and substance abuse through a wide range of support to help them deliver and nurture a healthy baby.

 

Healthy Rewards

Medicaid and Serious Mental Illness (SMI) Specialty Plan 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

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
$50 Substance Use Treatment for Pregnant Members Complete 5 Medication Assisted Treatment (MAT) visits before delivery
$10 Annual Well Child Visit Ages 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

Children’s Medical Services (CMS) Health Plan and Child Welfare (CW) Specialty 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

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 Ages 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