Many states have been taking a closer look at the experiences of pregnant and postpartum people amidst the persistent maternal health crisis, including reaching communities– most especially Black and Indigenous women and other communities of color who have not fared well in the traditional, clinical health care system. We at CCF have championed states electing to extend postpartum periods to 12 months, especially, have an additional obligation to ensure the postpartum months are implemented with attention to the ways Medicaid can more effectively address maternal and infant health during a critical and time-sensitive period of family change.

At the federal level, the Administration has made maternal health a top priority, grounded in the White House Blueprint for Addressing the Maternal Health Crisis. Most recently, HHS released additional grant funds and launched the Maternal Mental Health Task Force.

In Medicaid, the predominant payor of US births and infants, states don’t need to wait for federal action to do more to support maternal and infant health. CMS has championed and strengthened opportunities through its Maternity Care Action Plan and a postpartum care learning collaborative. Among the things we’ve highlighted around coverage and care access, states can:

• Increase eligibility or streamline enrollment for pregnant women in Medicaid, starting with Medicaid expansion.
• Adopt the option to extend postpartum coverage for pregnant women in Medicaid to 12 months – only 4 states have yet to act.
• Grow the community-based workforce by allowing Medicaid to cover doulas and perinatal community health workers (CHWs). (Timely that our friends at NASHP just updated their tracker on states using Medicaid to fund CHWs.)
• Expand the range of maternal health providers, including birth centers and
• Support home visiting for pregnant women or young children in Medicaid.

To continue to spur state action, last month CMS announced another new state grant opportunity to further propel maternal health care reforms. CMS’s Innovation Center will fund states seeking to adopt the Transforming Maternal Health (TMaH) model, a whole-person approach for people enrolled in Medicaid during pregnancy, birth and the postpartum period. The initiative seeks to reduce disparities in access and treatment and to “improve outcomes and experiences for mothers and their newborns, while also reducing overall program expenditures.”  As many as 15 states, led by their Medicaid agencies, will be chosen to receive up to $17 million over 10 years to implement TMaH statewide or in selected communities, requiring or encouraging many of the Medicaid changes, such as doula care, that have been well-established best practices recommended by CMS-convened expert panels.

States need not wait for an innovation grant to spur Medicaid support for best practices that can play a big role– especially as it relates to addressing health equity. But hopefully the additional grant funding and accompanying TA support may compel state leaders to do even more.

So what’s next? CMS will release a Notice of Funding Opportunity (NOFO) in Spring 2024, with applications due in the summer. Is your state primed to apply?

For more information on TMaH:

Fact Sheet: https://www.cms.gov/files/document/tmah-fs.pdf

FAQs https://www.cms.gov/tmah-model-frequently-asked-questions

Journey Map: https://www.cms.gov/files/document/tmah-journey-map.pdf