Expanded Coverage for Spinal Muscular Atrophy - Prenatal Carrier Testing

Date Issued: 11/25/2014

Effective December 1, 2014 prenatal carrier testing for spinal muscular atrophy (SMA) is covered, once in a lifetime for Medicaid Managed Care and Family Health Plus* (FHPlus) when one or more of the following criteria is met:

  • There is a personal or family history of SMA or other muscular dystrophy of unknown type in a 1st or 2nd ** degree relative of either parent.
  • The father is a known carrier.

Carrier screening for spinal muscular atrophy of the male partner in a pregnancy is only covered if the pregnant female is found to be a carrier. EmblemHealth maintains a contract with Quest Diagnostics Inc. to provide outpatient clinical services to our members. In order to ensure that members receive the highest level of plan benefits, laboratory specimens must be referred to Quest Diagnostics for analysis.

Note: Quest is able to provide most laboratory services. For specialty lab tests not available from Quest, we have contracts with other labs. For network hospitals with their own lab contracted with EmblemHealth, physicians may use this lab rather than Quest if applicable.

*Only covered for FHPlus members until December 31, 2014.

**1st degree relatives: parents, children and siblings
2nd degree relatives: grandparents, aunts and uncles, nieces and nephews
and grandchildren