Medicaid is the largest single payer of pregnancy-related services, financing nearly half of the births in the United States.
Recognizing the critical role that Medicaid plays in the U.S. maternal health crisis, state agencies have increasingly focused their attention on maternal health improvements; including better reporting strategies, expanded definitions of risk, and funding for services outside the traditional scope of pregnancy care, such as doulas and mental health care.
The federal government has also put attention and resources toward the issue, including legislation enacted in 2022 that allows states to permanently guarantee 12 months of Medicaid postpartum care.
On December 15th, CMS introduced the Transforming Maternal Health (TMaH) Model, the latest federal initiative aimed at improving maternal health care, designed to focus exclusively on people enrolled in Medicaid and Children's Health Insurance Program (CHIP).
Aimed to support SMAs in developing resources that address the physical, mental health, and social needs experienced during pregnancy, childbirth and postpartum; the model is unique for its expansive scope and marks a major step toward advancing a whole-person approach to maternal health.
CMS support for participating SMAs falls into the following three categories:
Medicaid beneficiaries, particularly in rural zipcodes, are more likely to live in maternity care deserts than those with commercial or private insurance. Limited access to the full range of maternity care providers or puts these patients at higher risk of complications, and an ongoing physician shortage creates obstacles to access.
TMaH will help participating states increase access to care through valuable resources such as midwives, birth centers, doulas and community based organizations, which have been shown to promote better outcomes for those in under resourced areas.
To encourage implementation of evidence-based safety practices, CMS introduced the "birthing-friendly" designation in November of 2023, identifying hospitals and health systems that participate in a statewide or national perinatal quality improvement collaborative program and that implement evidence-based care to improve maternal health.
TMaH will aid SMAs in promoting these practices at their hospitals and health systems through implementation of patient safety bundles. Implemented consistently, these have been shown to improve health outcomes across clinical areas, including hypertension during pregnancy, cardiac conditions, and care for pregnant and postpartum people living with substance use disorders.
Maternity care has traditionally focused on the clinical variables attending a pregnancy. Increasingly, research has revealed the importance of addressing the range of variables that impact a mother's health and well-being -- not just clinical variables, which only affect about 20% of outcomes, but social and behavioral issues, which impact more than 50%. However, inconsistent screening for social and behavioral risks, as well as lack of resources to address identified risk, makes it difficult to successfully promote whole-person care.
The TMaH Model will help participating SMAs support personalized maternity care by better risk screening for mothers during their initial prenatal visit, and offer resources if any additional needs are identified. Mothers will be included in a shared-decision making process, working together to create a plan for their health and, where appropriate, remote monitoring of conditions like hypertension and diabetes may be offered to reduced the burden of traveling to and from a doctor’s office, or connected to a community health worker depending on their social risks.
Who is eligible?
From CMS.gov: "TMaH is a state-based model, in which state Medicaid agencies serve as model awardees. Along with state Medicaid agencies, Managed Care Organizations (MCOs), Perinatal Quality Collaboratives, hospitals, birth centers, health centers and rural health clinics, maternity care providers and community-based organizations are critical collaborators to model success. CMS will issue Cooperative Agreements to up to 15 state Medicaid agencies."
What we know about next steps:
CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in Spring 2024. Applications will be due in Summer 2024.
This initiative offers tremendous opportunity to implement innovative approaches for improving maternal health and promoting value-based care. With our many years of experience working with under resourced populations, we're encouraged by the expansive nature of the model and optimistic about its impact.
Learn more about how Babyscripts is improving maternal health for Medicaid populations: