Eligibility and covered services
As a provider, it is important to have any pregnant MassHealth member in your care report their pregnancy to MassHealth so they are assigned the appropriate coverage type. Self-reporting pregnancy status as early as possible ensures members can access all the benefits they're eligible for during pregnancy and through 12 months after delivery, inclusive of all pregnancy outcomes and regardless of the patient’s immigration status. Even people who didn’t qualify for MassHealth previously may now qualify due to pregnancy status.
Visit mass.gov/masshealthpregnancy for more information about self-reporting, covered services, and resources for pregnant and postpartum members.
If you see pregnant patients, we encourage you to keep the printed notification of pregnancy form available so members can complete the form during their first prenatal care visit. The completed form can then be mailed or faxed to MassHealth by the provider office.
While there are some exceptions, most pregnant and postpartum members are eligible for MassHealth Standard coverage as long as they report their pregnancy status to MassHealth, regardless of their immigration status.
Note that MassHealth does not require referrals for pregnancy-related care. If you encounter barriers that prevent a member from getting timely prenatal care, call the MassHealth Customer Service Center for Providers at (800) 841-2900.
Covered services for pregnant and postpartum MassHealth members include but are not limited to:
- Prenatal, labor and delivery, and postpartum care through 12 months, including care in hospitals and freestanding birth centers
- Sexual and reproductive health care including many family planning services
- Doula services
- Behavioral health care including mental health and substance use disorder treatment
- Dental care including checkups, cleanings, fillings, crowns, and root canals
- Transportation for eligible members when needed
- One free breast pump per pregnancy, milk storage bags, replacement parts as needed, hospital-grade breast pump rentals as needed
- Prenatal screening, ultrasounds, and vaccines
- Prenatal vitamins
- MassHealth members can get prenatal vitamins free of charge at their local pharmacy without a prescription from their provider because of MassHealth’s standing order.
- Remote patient monitoring during pregnancy through 12 months postpartum (for example, remote blood pressure monitoring)
MassHealth covers some services, including enteral nutrition and special medical formulas, with prior authorization based on medical necessity.
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Managed care information and supports
While there are some exceptions, most pregnant and postpartum MassHealth members are eligible for enrollment in a managed care plan as long as they report their pregnancy status to MassHealth.
The majority of pregnant and postpartum MassHealth members in managed care plans are enrolled in an accountable care organization (ACO), managed care organization (MCO), or primary care clinician (PCC) plan. There are two different types of ACOs: Accountable Care Partnership Plans (ACPPs) and Primary Care ACOs (PCACOs). Members and providers can learn more about ACOs, MCOs, and the PCC Plan at masshealthchoices.com.
Some pregnant and postpartum members with a disability may be in an integrated care plan called One Care. Other members may have MassHealth fee-for-service (FFS) coverage. Members on FFS are not eligible for managed care services.
As their provider, you should encourage your patients to contact their managed care plan, if they have one, since they may be eligible to receive additional supports such as care management, housing and nutrition supports, free car seats, and more. If a member isn’t sure what managed care plan they have, or if they are eligible for managed care, they should call the MassHealth customer service center at (800) 841-2900, TDD/TTY: 711. For extra support understanding their coverage, members can also contact My Ombudsman.
| Managed care service or resource for pregnant and postpartum members | ACO | MCO | PCC | One Care |
|---|---|---|---|---|
| Basic care coordination services | ✓ | ✓ | ✓ | ✓ |
| Care management programs may be available for certain high-risk members | ✓ | ✓ | ✓ | ✓ |
| Housing and nutrition supports for certain high-risk members | Services vary by plan | X | X | Housing and nutrition supports for all members |
| Community Partners program for behavioral health or long term services and supports, for certain members | ✓ | ✓ | X | X |
| Extra benefits like free car seats, diapers, childbirth education classes, etc. | Varies by plan | Varies by plan | X | Varies by plan |
✓ = Applicable, X = Not applicable
MassHealth doula benefit
MassHealth covers doula services for eligible MassHealth members while they are pregnant, during delivery, and up to 12 months after delivery, inclusive of all pregnancy outcomes, and for members who are adoptive parents of infants under one year old.
MassHealth covers doula support during labor and delivery (which includes support during miscarriage or abortion) and up to 8 hours of perinatal visits, which can be used at any time during pregnancy and within 12 months after the pregnancy ends. Perinatal visits above the up to eight-hour limit require prior authorization.
More information:
- How to help your patient find a MassHealth doula provider
- Details about the MassHealth doula program including eligibility, enrollment, and billing
- MassHealth’s standing recommendation for doula services and medical necessity guidelines for additional perinatal visits
Behavioral health
MassHealth covers several behavioral health screening and treatment services, which can be billed outside of the global obstetric fee.
There are also programs and resources for perinatal mental health and substance use disorder provided by agencies or organizations outside MassHealth.
- Emergency/crisis: For emergency or crisis concerns, providers and/or patients may call the Massachusetts Behavioral Health Hotline (833-773-2445) to talk to a trained mental health professional for real-time clinical assessment and direct access to community mental health resources such as mobile crisis evaluation and referral to a Community Behavioral Health Center for evaluation and ongoing care.
- Free consultation through MCPAP: Providers can contact MCPAP for Moms for live behavioral health consultation and referrals at 855-666-6272. Explore MCPAP for Moms’ perinatal mental health and substance use disorder guidance and resources for clinicians.
- Perinatal depression screening: MassHealth pays for depression screenings during pregnancy and through 12 months postpartum in primary care, pediatric, and obstetric settings outside of the global obstetric fee. MassHealth also has specific requirements for postpartum depression (PPD) screening.
- Review PPD screening requirements for pediatric providers under Early and Periodic Screening, Diagnosis and Treatment (EPSDT).
- Important information and resources from the MA Department of Public Health (DPH):
- Review perinatal mood & anxiety disorders (PMADs) resources for healthcare providers including recommended screening tools, sample scripts, an overview of treatment options, and more. Explore more resources for providers and patients on MA DPH’s PMAD landing page.
- Review substance use and mental health resources for pregnant and parenting individuals including recommended screening tools, helplines, clinical guidance, and more.
- Learn about the MA roadmap for behavioral health reform.
Breast pumps and lactation support
Breast pumps are covered under the Durable Medical Equipment (DME) benefit. MassHealth covers one manual or one electric breast pump per pregnancy, milk storage bags, and replacement parts as needed, without prior authorization. Prior authorization is required for more than one pump per pregnancy. MassHealth also covers hospital-grade pump rentals, subject to prior authorization.
For members receiving services on a fee-for-service (FFS) basis, through the Primary Care Clinician (PCC) plan, or a MassHealth Primary Care ACO (PCACO), you can request these directly for your patient through an enrolled MassHealth durable medical equipment (DME) provider. In cases where a member contacts a DME provider directly, the DME provider may request a prescription from you as the clinical provider.
For members in a Managed Care Organization (MCO), Accountable Care Partnership Plan (ACPP), or One Care plan, contact the plan directly for information about coverage processes and DME providers in the plan’s network.
If you have questions, contact the member’s MassHealth health plan or MassHealth Customer Service Center for Providers at (800) 841-2900.
Members may be eligible for additional breastfeeding or lactation support resources outside MassHealth.
Family planning
- Birth control pills: Most MassHealth members are eligible to get 12 months’ worth of oral hormonal contraceptives. Members can also get over-the-counter oral hormonal birth control free of charge at their local pharmacy without a prescription from their provider because of MassHealth’s standing order.
- LARC: MassHealth covers postpartum long-acting reversible contraceptive (LARC) placement outside of the global obstetric fee. Access MassHealth’s hospital billing guidelines for postpartum LARC placement.
- Permanent sterilization: MassHealth covers procedures for permanent sterilization for members of any gender. Federal law requires that Medicaid enrollees sign a consent form and wait 30 days for the procedure.
- Sexual and reproductive health: Learn more about MassHealth covered sexual and reproductive health services including family planning.
Prenatal screening/diagnosis and vaccines
Note that the below services can be billed outside the global obstetric fee.
- Genetic screening: MassHealth covers standard tests for prenatal genetic screening, including non-invasive prenatal testing, without prior authorization. MassHealth also covers diagnostic testing with chorionic villus sampling (CVS) and amniocentesis as indicated for members with abnormal screening results.
- Ultrasounds: MassHealth covers ultrasounds for nuchal translucency and the second-trimester anatomy scan. Additional ultrasounds as indicated for complications during pregnancy are also covered.
- Vaccines: MassHealth covers all standard vaccinations recommended during pregnancy, including vaccines against influenza, pertussis, and RSV. In most cases, prior authorization is not required.
Social determinants of health (SDOH)
There are several programs and resources addressing SDOH that MassHealth members may be eligible for, including many offered by agencies or organizations outside MassHealth. Below are a few examples.
MassHealth transportation benefit
Providers with members in MassHealth Standard, CommonHealth, or CarePlus can submit a PT-1 request for eligible members when transportation is a barrier to accessing care. For members in One Care plans, contact the plan directly to request transportation services.
The transportation benefit can also be used in cases where a parent, family member, or caregiver needs to participate in treatment for the direct benefit of a MassHealth member under age 21 who is receiving care in a facility so that they can actively participate in the treatment/intervention for the direct benefit of the child – for example, transportation to the neonatal intensive care unit (NICU) to participate in skin-to-skin, infant feeding, or discharge planning.
Paid family and medical leave (PFML)
PFML is a program designed to help people in Massachusetts take paid time off of work for family or medical reasons. Many pregnant MassHealth members are eligible for PFML. As a health care provider, you play an important role in the PFML application process. Learn more about how as a health care provider you can help your patients apply for PFML.
WIC
Most pregnant MassHealth members are eligible for the Women, Infants, & Children Nutrition Program (WIC). WIC provides healthy foods, nutrition education, breastfeeding support, and referrals to healthcare and other services, free of charge to Massachusetts families who qualify.
Home visiting
The MA Department of Public Health offers several free, voluntary, and confidential home visiting programs for eligible families expecting a child or eligible families with young children. Note that these programs vary in terms of eligibility criteria and geographic availability.
The Children's Trust offers the Healthy Families Massachusetts free home visiting program, which supports first-time parents age 23 and under and is available statewide.
Massachusetts Early Intervention is a free program for infants and toddlers (birth to 3 years old) who have developmental delays or are at risk of a developmental delay, available statewide.
Family Resource Centers
Family Resource Centers are a statewide network of community-based providers offering multicultural parenting programs, support groups, early childhood services, and education for families with kids up to 18 years old.
More information and resources
Patient-facing materials
| Material | DOCX | |
|---|---|---|
| Health Promotion Materials for MA residents and providers (source: MA Department of Public Health’s clearinghouse) | ||
| MassHealth Doula Flyer (source: MassHealth Doula Services Program: Information for Doulas) | ||
| MassHealth Notification of Pregnancy Form (source: MassHealth Member Forms) | ||
| MassHealth Pregnancy Checklist | ||
| Paid Family Medical Leave (PFML) for New Expectant Parents (source: Economic Benefits for Families) | ||
| Stillbirth Prevention Educational Materials - Available to order for free (source: Count the Kicks) | ||
| WIC Outreach Brochure (source: Check eligibility for WIC) |
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| Date published: | July 21, 2025 |
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