Medicaid Model Takes Whole-Person Approach to Maternal Health

The Centers for Medicare & Medicaid Services (CMS) has announced a new payment model designed to focus on improving maternal healthcare for people enrolled in Medicaid and Children's Health Insurance Program (CHIP).

The Transforming Maternal Health (TMaH) Model will support participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy. The goal of the model is to reduce disparities in access and treatment. The model aims to improve outcomes and experiences for mothers and their newborns, while also reducing overall program expenditures.

The model is projected to run for 10 years.

A notice from CMS outlined the scope of the problem: “Despite spending more per capita on maternal healthcare than any other nation, the U.S. has disproportionately high rates of adverse pregnancy outcomes as compared to other high-income nations. The TMaH Model provides SMAs with targeted support in the form of funding and technical assistance. The goal of this support is to improve maternal health care and birth outcomes while reducing associated health disparities.  This support also enables states to develop a value-based alternative payment model for maternity care services which will improve quality and health outcomes and promote long term sustainability of services.”

CMS described three main pillars of TMaH’s initiatives:
• Access to care, infrastructure, and workforce capacity: TMaH will support relationship building and education to help participating states address barriers that limit access to valuable resources, such as midwives, doulas, and perinatal community health workers (CHW). Greater access to these resources can have numerous benefits, including reduction in cesarian sections (c-sections) for low-risk pregnancies, shortened labor time, lower utilization of pain medication during birth, and lower rates of postpartum anxiety and depression. Participating SMAs will be able to promote care that is person-specific, culturally sensitive, and rooted in active listening and development of trust, with a goal of making mothers more empowered to manage their birth experience. 
• Quality improvement and safety: Participating SMAs will implement quality initiatives and protocols with a goal of making childbirth safer and improving both the mother and baby’s overall experience. These evidence-informed interventions are called “patient safety bundles.” When implemented together and consistently, these protocols are shown to improve health outcomes across several clinical areas, including hypertension during pregnancy, cardiac conditions, and care for pregnant and postpartum people living with substance use disorders.  Participating SMAs will also work with their hospitals and health systems toward achieving the CMS “Birthing-Friendly” designation, which is the first federal quality designation with a focus on maternal health for hospitals and health systems. 
• Whole-person care delivery: Pregnancy and birth are deeply personal experiences, and every person’s journey is unique. Under the TMaH Model, participating SMAs will strive to ensure that every mother receives care that is customized to meet their specific needs by supporting the development of a unique birth plan. Individuals will be screened during their initial prenatal visit to determine what, if any, additional supports they may need for health-related social needs, mental health, or substance use disorder.  Based on their physical, social, and mental health needs, a care plan will be developed in collaboration with the mother. Where appropriate, remote monitoring of conditions like hypertension and diabetes may be offered to reduce the burden of traveling to and from a doctor’s office. People may also be connected with community organizations or a community health worker depending on health-related social needs they may have.

CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in Spring 2024. Applications will be due in Summer 2024.