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Stay Connected on the Go! Download our Health Insurance Portal mobile app to search for care, view benefits and access your Member ID card. LEARN MORE AND DOWNLOAD THE APP

Maternity Benefits and Member Support

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.

These resources are designed to help providers monitor and improve the physical and mental conditions of their patients that can result in complications before, during and after pregnancy. Sunshine Health’s goal is to help providers address their patients’ health issues before they become health risks that could complicate our members’ pregnancies and births.

Providers should recognize the physical and mental signs that patients need care and train new mothers and their support network to monitor their health and recognize when they should seek help. The Centers for Disease Control and Prevention offers tips to help lower the risk of pregnancy complications:

  • Once pregnancy has been diagnosed, the expectant mother should begin early prenatal care. They should discuss their current and past health conditions with their healthcare provider and make them aware of any complications from past pregnancies.
  • During pregnancy, providers should monitor and warn their patients about chronic conditions that can arise during and after pregnancy, such as diabetes, depression and hypertension.
  • After birth, mothers should continue seeing their healthcare providers for postpartum care. Providers should educate new mothers and their support network about these urgent maternal warning signs and symptoms. 
  • 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.
  • Providers and family members should listen to women during and after pregnancy and respect their concerns.
  • The CDC estimates that more than 80% of pregnancy-related deaths are preventable if providers, family and support networks act to help new mothers.

Resources to Help Members

Sunshine Health Member Services

Community Connections Team

Maternal Provider Incentive Programs

Sunshine Health offers an array of incentive programs to help providers ensure healthy outcomes for both mothers and their newborns. To learn more, visit Maternity Incentive Programs

Member Benefits and Programs

Standard Benefits

  • Obstetrician-Gynecologist (OB-GYN) visits (no limit).
  • Reproductive services for members who are pregnant or trying to become pregnant.
  • Confidential family planning services without prior approval for 18 years of age and under.
  • Primary care physician (PCP) visits for mother and child (no limit).

Medicaid Expanded Maternal/Child Benefits

These benefits are for members of these products:

Benefits:

  • 24/7 lactation support
  • Baby book
  • 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
  • Fatherhood engagement referral program
  • First Year of Life safe sleep
  • Fresh funds
  • Home delivered meals for pregnant members*
  • Mom care bundle
  • Non-emergency medical transportation
  • Nutritional counseling*
  • Over-The-Counter (OTC) baby supplies
  • Ready for baby bundles
  • Remote patient monitoring
  • Swimming lessons for children
  • Welcome Baby! Bundle
  • YMCA membership

* Prior authorization required.

Special Programs

  • 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.
  • 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 that also offers referrals to healthcare, immunizations and community services.

Mental Health Special Programs

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 six months of the calendar 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:

Maternal Member Healthy Rewards

For members of:

  • Sunshine Health Medicaid (MMA)
  • Sunshine Health Pathway to Shine Specialty Plan (CWSP)
  • Sunshine Health Mindful Pathways Serious Mental Illness Specialty
    Plan (SMI) Plan
  • Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)

Members can learn more about these rewards by visiting My Health Pays® Rewards.

Maternal Member Healthy Rewards

Amount

Activity

Description

$25

Notification of Pregnancy (NOP) Form (First Trimester)

Sign completed NOP form

$50

Prenatal Visit First Trimester

Complete first prenatal visit within first trimester or within 42 days of enrollment

$50

Doula Engagement

Ages 13 years and older. $50 per pregnancy.  

$400

Substance Use Treatment for Pregnant Members

Complete Initiation and Engagement of Substance Use Disorder Treatment (up to three visits) and complete five coaching sessions with a Care Manager prior to delivery. $400, one reward per pregnancy.  

$25 (up to $100)

Prenatal Visits

Complete up to four prenatal visits

$20 per year

Puff-Free Pregnancy

 

Complete four tobacco cessation coaching sessions within six months of the first calendar year

$40

Postpartum Visit

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

$25

Annual Well Child Visit (WCV) Ages 0-21 Years

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

Newborn well-child visit encouraged

$20

Lead Screening, Children under Age 2 Years

Complete a blood test for lead poisoning screening by second birthday