Health Plan of San Joaquin offers support to members and providers through prenatal and postpartum care for our Medi-Cal members through our Me & My Baby Program in order to promote maternal wellbeing.
This includes that, Licensed Health Care Practitioners who offer prenatal and postpartum care, offer:
- Screening for any type of mental health condition that may be occurring.
- Referral to supportive services that may benefit the member.
- Linkages to our Me + My Baby program.
For Providers, HPSJ promote the following steps to support Maternal Mental Health:
|Clinical Practice Guidelines and Resource learning
The Centers for Medicaid and Medicare have developed a toolkit of many resources for various practices who serve the prenatal and postnatal populations. To learn more, go here.
|Importance of Maternal Mental Health
- 1 in 5 women experience mental health concerns during pregnancy and after childbirth, but most go undetected and untreated.
- Maternal mortality continues to rise in the U.S. and mental health is the leading preventable cause of death.
- Maternal mental health disorders can have a significant impact on a mother’s health and wellbeing
- At least once during each pregnancy AND
- At least once within 12 weeks following the birth of the child
G8431 should be applied when the screening for depression is being documented as positive and a follow-up plan is documented.
G8510 should be applied when results of the screening for depression are documented as negative and a follow-up plan is not required.
All members whose screening results indicate a positive identification of potential depression or other mental health condition, may be referred for mental health services.Members may refer directly to our network of providers:
Online Provider Directory tool
Mental Health Customer Service line: 888-581-PLAN (7526)
Substance Use services include Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) for members 11 years old and older, including pregnant women. These services are provided by PCPs.
Annual screenings for alcohol and drug use
Unhealthy alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:
- Cut Down-Annoyed-Guilty-Eye-Opener Adapted to Include Drugs (CAGE-AID)
- Tobacco Alcohol, Prescription medication and other Substances (TAPS)
- National Institute on Drug Abuse (NIDA) Quick Screen for adults
- The single NIDA Quick Screen alcohol-related question can be used for alcohol use screening
- Drug Abuse Screening Test (DAST-10)
- Alcohol Use Disorders Identification Test (AUDIT-C)
- Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents
- Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents
- Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population.
When a screening is positive, validated assessment tools should be used to determine if unhealthy alcohol use or SUD is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools. Validated assessment tools include, but are not limited to:
NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
Drug Abuse Screening Test (DAST-20)
Alcohol Use Disorders Identification Test (AUDIT)
Discussing negative consequences that have occurred and the overall severity of the problem;
Supporting the patient in making behavioral changes; and
Discussing and agreeing on plans for follow-up with the patient, including referral to other treatment if indicated.
Referral to treatment
Medi-Cal members have access for Treatment beyond the Scope of a PCP through the Access line available within their county:
ACCESS Line: 1-888-468-9370
ACCESS line: 1-888-376-6246
Services within the scope of mental health providers can connect to Carelon at 1-888-581-PLAN (7526)
HPSJ covers a variety of transgender-specific services (gender-affirming care) as a benefit when services are medically necessary. These services include:
- Psychological assessment (to determine readiness for surgery and/or procedures)
- Hormone therapy
- Gender affirming surgeries and procedures
Coverage for treatment
Primary care doctor for routine preventative care, regardless of gender marker
Medi-Cal Transgender-specific care
Mental health therapy (unrelated to assessments for gender-affirming care) through HPSJ’s mental health network
For more information about specific coverage for behavioral health services
Behavioral healthcare services are coordinated through Carelon Behavioral Health at 1-888-581-7526 (PLAN)