In December 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new model called the Transforming Maternal Health (TMaH) Model, the first of its kind to focus solely on improving maternal health care for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries. The model is intended to support state Medicaid agencies to address the physical health, mental health and social needs of mothers by developing whole-person approaches to pregnancy, childbirth, and postpartum care. The model's overarching goal is to reduce disparities in access and treatment and to improve outcomes and experiences for mothers and their newborns. On June 26, 2024, CMS released the Notice of Funding Opportunity (NOFO) for states to apply. The NOFO will close for applications on September 20, 2024.
Transforming Maternal Health (TMaH) Model Overview
This model will give state Medicaid agencies targeted funding and technical assistance to develop a value-based alternative payment model for maternity care services. The model has three main pillars that center around (1) access to care, infrastructure, and workforce capacity; (2) quality improvement and safety; and (3) whole-person care delivery.
Access to care, infrastructure, and workforce capacity
This pillar addresses barriers that limit access to resources such as midwives, doulas, and perinatal Community Health Workers (CHWs). The model will support relationship building and education to help participants have greater access to these resources. CMS has stated that having access to doulas and midwives can reduce the number of c-sections for low-risk pregnancies, shorten labor time, lower the utilization of pain medications during birth, and lower rates of postpartum anxiety and depression. Additionally, this pillar will also help enhance data collection exchange and linkages in electronic health records (EHRs) between providers and Community Based Organizations (CBOs).
Quality improvement and safety
Participating states will implement evidence-informed interventions called "patient safety bundles" which are quality protocols that are intended to make childbirth safer and improve the mother and baby's overall experience. CMS noted that patient safety bundles are shown to improve several health outcomes such as hypertension during pregnancy, cardiac conditions, and care for pregnant and postpartum people living with substance use disorders when implemented consistently.
This pillar supports state Medicaid agencies in working towards achieving CMS's "Birthing Friendly" designation, the first federal quality designation to focus on maternal health for hospitals and health systems.
There is also the option for states to work at promoting shared decision making between mothers and providers.
Whole-person care delivery
Under this pillar, participating states will have the opportunity to ensure that every mother receives customized care and support to develop their own birth plan. Beneficiaries will get screened with an evidence-based medical and social risk assessment during their initial prenatal visit to determine their physical, mental, and social health needs and whether they need any additional support for their care plan. Individuals can also be connected to community organizations or community health workers depending on their health-related social needs (HRSNs). States can also implement routine screenings and follow-ups for HRSNs, perinatal depression, anxiety, and tobacco and substance use during prenatal and postpartum periods.
The TMaH model also includes a specific health equity strategy to address health disparities among underserved populations, people living in rural areas, and racial and ethnic groups. States will be required to develop and implement a Health Equity Plan and must tailor their plan to a specific population while considering language support for non-native English speakers, access to transportation services, and improvements to address gaps in care. The model also encourages states to extend their Medicaid and CHIP postpartum coverage to 12 months to promote preventive care, overall health, and reduction of care costs. Although states are required to develop their own Health Equity Plan, they will receive tailored technical assistance to support providers in rural, Tribal, or other high need areas, to increase capabilities to screen for HRSNs, and to support the overall creation of the Health Equity Plan.
Model phases and participation
There is a 3-year Pre-implantation Period where participating states will receive targeted technical assistance to achieve pre-implementation milestones followed by a 7-year Implementation Period for a total of 10 years. The model will begin in January 2025. CMS will select up to 15 states (including from all 50 states, District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands) to receive up to $17 million in funding. Managed Care Organizations (MCOs), Perinatal Quality Collaboratives, hospitals, birth centers, health centers and rural health clinics, maternity care providers and community-based organizations can collaborate with state Medicaid agencies to implement the model.
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