Released in late October, the most recent House text of the Build Back Better plan included an exciting late addition: a new Medicaid pathway to incentivize high-quality, team-based care for pregnant and postpartum people. The new state option provides a temporary enhanced match to develop and grow practices to comprehensively anticipate and coordinate care needs, more intensively as necessary. The new option also has potential to ensure postpartum care is managed alongside that of newborns during the 12 months after birth, recognizing the parent-child relationship that underpins early brain development.
The bill creates a new Medicaid state plan amendment option for states to provide coordinated care through a “maternal health home,” which serves as a hub for pregnant and postpartum people to receive care from a team of medical care and social services providers. The option builds on the foundation of a new proposed requirement that all states cover pregnant people for 12 months postpartum, also included in the Build Back Better proposal. The maternal health home provider teams would serve Medicaid beneficiaries from pregnancy through 12 months postpartum.
What qualifies as a “maternal health home”?
According to the draft language, to qualify for enhanced payments as a maternal health home, a practice or related care organization must, in a culturally and linguistically appropriate manner, create an individual care plan based on each beneficiary’s needs and choices that addresses:
- primary and inpatient care
- behavioral health
- social support services
- care management and planning for health coverage changes
The proposed bill also specifically directs the maternal health home to coordinate all services related to labor, delivery and postpartum care, including specialists.
The language also recognizes the interwoven relationship between caregiver and newborn health by specifically directing maternal health homes to coordinate services with pediatricians and early intervention specialists.
Care can be provided at individual or group physician offices, community health centers, freestanding birth centers, academic medical centers, children’s hospitals, via telehealth or any other care entity as designated by the state and approved by CMS.
Who is on the care team?
Teams can be made up of physicians, midwives, doulas, community health workers, behavioral health specialists, translators, or any other providers defined by the state.
The opportunity with this new option is to provide new incentives for quality team-based care that better addresses the specific needs of each pregnant and postpartum person choosing to participate. Outside of the pregnancy itself, no other qualifying conditions or factors are necessary for a beneficiary to receive enhanced care from a maternal health home. This is a key distinction from the Affordable Care Act health home option, which requires states to designate eligibility based on higher care needs due to chronic conditions, diagnoses, or specific risk factors. While providers within the maternal health home would screen each patient for medical risk factors to develop an individualized care plan, the proposed language would make health home services available to any pregnant or postpartum Medicaid
How can providers get paid?
The bill also makes clear that maternal health homes are able to use alternative payment models, and that payment to providers is not limited to fee-for-service or per-member-per-month capitation payments. Alternative payment models must be approved by the Secretary, but offer room for states to think differently about paying for person-centered care.
What data will be collected?
As Say Ahhh! Readers know, finding data on care quality and outcomes in Medicaid and CHIP can be a challenge, with state work to improve transparency and availability of data on the rise. The bill makes clear that states will have to report a suite of data to CMS on participating health homes in exchange for the enhanced federal matching funds. Among the requirements, health homes must report enrollment and quality data, including the CMS Medicaid and CHIP Child Core Set and Adult Core Set. They will also be required to report hospitalizations, morbidity and mortality of any of their pregnant and postpartum patients and their infants, alongside comparable data from the state’s maternal mortality review committee. This will be a key area to watch for demonstrated progress in reducing maternal and infant mortality and morbidity as well any service gaps or challenges that may remain to be addressed to ensure the best possible care.
Last but not least, states must report on the race and ethnicity of all enrollees and health home providers.
Timeline for Maternal Health Home, Extended Postpartum Coverage Implementation
|Build Back Better Date of Enactment (DOE)||TBD if passed|
|April 1, 2022||Federal funds may support ARPA 12-month postpartum option||Regular state FMAP|
|One year after Build Back Better DOE – TBD*||Mandatory 12 months of postpartum coverage in Medicaid and CHIP begins in all states||Regular state FMAP|
|One year after Build Back Better DOE – TBD*||Maternal health home planning grants available to states||$5 million in federal planning grants are available subject to a state contribution.|
|Two years after Build Back Better DOE – TBD**||Federal funds may support the maternal health home SPA option to qualifying providers||State’s regular FMAP + 15 percentage points to a cap of 90%
Available for 2 years then sunsets to regular state FMAP
*December 2022 if passed in December 2021
At its heart, this option recognizes the needs for prenatal and postpartum care to go beyond just a one-on-one interaction between a patient and doctor. Instead, the bill incentivizes a care approach to address the medical and social needs of the patients and their families during a high-stakes time of maternal health and early childhood development.
Incentivizing this approach to whole-person care should help ensure, for instance, that families struggling to afford housing, diapers, or transportation can get connected to helpers in their community. Broadening social support can help reduce family stress and make other health-related connections that can serve the well-being of both the parent and child, which are intertwined in the early weeks, months and years of a child’s life when healthy brain development is so crucial. Supports may include evidence-based home visiting or parenting programs designed to support a child’s social-emotional development, or referrals for early intervention assessments to help identify and address any developmental delays the child may experience before school begins. It’s an exciting opportunity to think differently about how communities can leverage Medicaid to support healthy maternal and child development.