The Sampson County Health Department offers a Prenatal Program, Pregnancy Care Management Services – CMHRP. The program has recently undergone a name transformation and is now referred to as Care Management for High-Risk Pregnancies – CMHRP.
The program was developed by the North Carolina Division of Public Health and the North Carolina Division of Medical Assistance and is designed to assist pregnant women with Medicaid eligibility and non-Medicaid eligible women who have priority risk factors to achieve a healthier pregnancy. Pregnancy Care Management serves pregnant women with Medicaid eligibility or non-Medicaid eligibility who have a priority Maternal Infant Impact Score (MIIS) associated with preterm birth, low birth weight, or other risk factors.
Medicaid Transformation to Managed Care became effective as of July 1 2021. Key objectives for Medicaid Managed Care are to show improvement in health plan performance, health care quality, and outcomes. Members are identified for the CMHRP Program through referrals made by health plans for prenatal women who are deemed priority patients. Care Management for High-Risk Pregnancies is provided as a benefit for health care services covered by health plans. Members are encouraged to become familiar with the standard and value-added benefits made available through the Health Plan they are enrolled in. Medicaid Recipients were enrolled in one of the five health plans.
• Healthy Blue
• Carolina Complete Health
• United Healthcare
• AmeriHealth Caritas
• Trillium Health Resources
Tailored Plans launched July 1, 2024.
Tailored Plans will provide the same services as Standard Plans in NC Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities, and traumatic brain injury.
The criteria for providing services to both Medicaid-eligible and non-Medicaid-eligible clients are the same; therefore, Pregnancy Care Management staff will ensure both populations receive the same high level of care management services and care.
Pregnancy Care Management services are provided by nurses and social workers with a focus on patient needs and risk status. The type and frequency of patient contacts are determined by the patient’s individual needs and care plan in order to effectively meet desired outcomes.
Prenatal care providers may refer patients for CMHRP services by completing the Pregnancy Risk Screening form at the initial prenatal visit for early identification of risk factors. If the pregnancy risk screening form is not utilized when making the referral, the Pregnancy Care manager will contact the patient to assess the presence of priority risk factors. Some priority risk factors include, but are not limited to:
• Hypertension
• A history of spontaneous preterm labor
• A history of low birth weight
• Unsafe living environment (homelessness, inadequate housing, domestic violence, or abuse)
• Substance Use
• Tobacco Use
• Antenatal hospital utilization
Services are available to any woman with Medicaid who lives in Sampson County, regardless of where she goes for prenatal care. Pregnancy Care Management staff receive a referral and contact the person for follow-up care. Any medical provider or agency that works with pregnant women can refer clients. Clients who have any of the above risk factors and are interested in the program can also contact the Pregnancy Care Management staff.
The Pregnancy Care Management staff provides the following services:
• Follow-ups on prenatal care issues and other clinical needs.
• Work with OB Providers and others who provide services to the pregnant woman to make sure everyone is aware of her concerns and needs.
• Provide education regarding: the need to keep all prenatal-related appointments; understanding and following the OB provider’s instructions; and the importance of getting postpartum care.
• Arrange/assist with the transition from the OB provider to a primary care medical home as needed for the woman after delivery if she remains or becomes eligible for Medicaid after the postpartum period.
If you are: a medical provider and would like to refer a client, a pregnant woman; know someone that may qualify for the program; or you would like more information on the Pregnancy Care Management Program, please call the Sampson County Health Department at 910-592-1131, ext. 4230