Presentation on theme: "Pregnancy-related care for undocumented individuals and non-citizens"— Presentation transcript:
1 Pregnancy-related care for undocumented individuals and non-citizens Soon-To-Be-SoonersPregnancy-related care for undocumented individualsand non-citizens
2 Soon-To-Be-Sooners (STBS) The Oklahoma Health Care Authority (OHCA) is strongly committed to providing optimal health care as well as making improvements that may contribute toward positive birth outcomes in our state. We are pleased to announce that pregnancy-related health care services have been expanded for the benefit of babies who will be born citizens of Oklahoma and the United States through the “Soon-To-Be-Sooners” (STBS) program.
3 Program & Policy Overview Program begins April 1, 2008Provides limited benefits for pregnancy-related careAvailable for undocumented or non-citizens who are pregnantBenefits for mother end at delivery
4 Program & Policy Overview continued… Pregnant women may apply for benefits through OKDHS or out station centersApplications may be downloaded atMembers receive an OHCA medical ID cardMembers are not eligible for Managed Care; excluded from SoonerCare ChoiceNot eligible for STBS if found to have other insurance (TPL)
5 Covered ServicesBenefits and covered services are those that impact the well-being of the pregnancy. For example:Office visits that impact the pregnancyLabs and some diagnostics related to the pregnancyHospital services for the birthHospital care for the newborn
6 Covered Services continued… Prescriptions for pregnancy related conditions as medically necessaryNo prior authorization needed for prenatal vitaminsPrior Authorization needed for all other Rx’sGenetic CounselingLactation Consultant servicesMaternal and infant health social work servicesPatient Advice Line
7 Non-Covered Services Dental services SoonerRide Vision (eye care) Services for conditions that do not impact pregnancy outcomeMedical services for the mother after the birth of the babyException--A postpartum visit is covered when provided as a component of the CPT billing code 59400
8 Checking EligibilityProviders will be able to check eligibility on this population as they would any other SoonerCare memberEligibility Verification System (EVS)OHCA’s Medicaid Secured Website
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