Insurance and Medicaid Prenatal Care Offerings


  • To understand what commercial insurance providers and Medicaid Managed Care organizations are doing with regards to improving prenatal care and delivery outcomes in New York State.
  • To understand which individuals at these companies are responsible for decision-making concerning prenatal care and delivery outcomes.


  • New York State's Medicaid program follow's the state's guidelines concerning prenatal care, which are outlined here.
  • "The Office of Health Insurance Programs, in collaboration with the Division of Family Health, IPRO and a statewide advisory work group made up of key stakeholders in the field of prenatal care" worked together to build a set of regulations and steps to be followed concerning prenatal care standards as followed by Medicaid in New York State.
  • The Department of Health recently expanded New York State's Medicaid program to cover doula services for members of the state's Medicaid Managed Care program. The program launched in March of 2019. The goal of this program is to help reduce maternal and infant death statistics, which are shown to occur at some of the highest rates in Erie and Kings Counties.
  • Members of New York State's Medicaid Managed Care program are entitled to a variety of family planning services both in- and outside their health plan. These services include birth control and emergency contraception, pregnancy tests, sterilization, testing and treatment for STDs and STIs, HIV testing and counseling, pap smears, and abortions.
  • There are a number of commercial health insurance companies operating within New York State, each of which provides different services with regards to prenatal care and improved delivery outcomes.
  • Pregnant women in New York State may be eligible for special health insurance options, such as those outlined here.
  • Pregnant women in New York State are automatically eligible for a special enrollment period through the Affordable Care act, meaning that they can enroll in commercial health insurance outside the typical enrollment period if they are uninsured.
  • All health plans offered through the Affordable Care Act are required to provide maternity care and childbirth services.

Proposed next steps:

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There appears to be a wealth of detailed information concerning how New York State's Medicaid Managed Care program handles prenatal and delivery care for members. We'd recommend a request providing full details and information on these programs, regulations, and offerings.
There appear to be certain teams and/or individuals who work with New York State's Medicaid Managed Care program to outline regulations and offerings concerning prenatal and delivery care. We'd recommend a request identifying these individuals or teams, along with contact information where appropriate/available. While information concerning the specific individuals responsible for this at private health insurance companies does not appear to be readily available, information should be provided about the state and federal organizations building regulations which apply to all private health insurance companies with regards to family planning care.
The types of prenatal and delivery care offerings provided by New York State's commercial health insurance providers appears to vary from one organization to the next, though certain specific offerings are required of any plan offered through the ACA Marketplace. We'd recommend a request outlining the required benefits, as well as 3-5 of the most commonly offered additional benefits.