Michigan has taken a comprehensive approach to maternal and child health policy, with a focus on strengthening Medicaid coverage and reimbursement, expanding community-based care, addressing racial disparities, and investing in prevention and maternal health systems. We asked Ta’Sheena Williams, Policy Director of the Michigan Council for Maternal and Child Health (MCMCH), to reflect on Michigan’s progress and what it will take to build a more equitable and sustainable maternal health system for families across the state. (The Q&A was minimally edited for brevity and clarity purposes.)
Michigan’s Policy Priorities and Gaps
Tanesha: “MCMCH’s 2026 policy agenda places significant emphasis on strengthening maternal health systems through access, reimbursement, prevention, and equity. From your perspective, what are the most pressing policy gaps currently affecting pregnant and postpartum people in Michigan?”
Ta’Sheena: “With a lot of things in limbo due to H.R.1, our biggest goal right now is ensuring and sustaining the system we currently have. Another big gap is Medicaid reimbursement for the full continuum of maternal health care — some services aren’t reimbursed at a level that makes them sustainable over time. Michigan has made important progress in recognizing the value of providers and services. We have coverage for doulas, we’re working on more coverage for lactation support, there’s been a lot of work around community health workers, and most recently, group-based prenatal care. But we know coverage alone is not enough. We need reimbursement policies that let these providers and models of care be truly integrated into the system and viable over time.
We also have to look at the Medicaid system as a whole and understand the cumulative impact of changes from H.R.1, eligibility, reimbursement, coverage, and administrative requirements. Michigan has made significant investments in maternal health, and protecting those gains will be especially important as the federal landscape continues to change.
We’re worried about people falling through the cracks as H.R.1’s work requirements roll out especially because pregnant women can fall into several different categories, and people aren’t always being notified correctly or labeled correctly in the system. We’ve been working with stakeholders and partners to elevate that message wherever we can, and it’s a general concern for advocates across the country as states like Nebraska begin implementing work requirements, we’ve already seen scary stories.
Ultimately, pregnant and postpartum people need access to care at the right time with the right providers, and those providers need to be supported so they can support our families. I’d say our largest gaps are around policy and reimbursement in the Medicaid space.”
Doulas, Midwives, and Birth Centers
Tanesha: “Michigan started implementing reimbursement for doula coverage in 2023. After about three years of implementation, how would you describe the integration of doulas in Michigan’s maternal health system?”
Ta’Sheena: “Doulas in our state are covered and received a reimbursement increase within the last two years or so. The increase did move doulas toward a more livable wage, but there are larger conversations happening too. We have a great relationship with the state-run Doula Advising Council in Michigan and they’re interested in extending coverage to private insurers as well. Most Medicaid providers who also have a mix of private-pay clients are more sustainable, so we’re hoping that mix helps. But because doulas in Michigan are largely limited to Medicaid or self-pay, sustainability is still a challenge.”
Tanesha: “With the passing of H.R.1, it is likely that there will continue to be a greater shortage of birth worker providers. Can you describe how midwives, both nurse and non-nurse midwives, and birth centers have been a vital source of support for maternal and child health in Michigan?”
Ta’Sheena: “Birth center births are typically for low-to-moderate risk and they have transfer plans in place in case of complications. We have a great relationship with Birth Detroit, a community-based birth center built with community funding and land from the land bank. The team at Birth Detroit has been very intentional about creating safer, community-centered spaces for families to give birth. We’ve taken steps to strengthen midwifery and birth center care. We recently made progress on reimbursement for licensed nurse midwives, and last year we passed legislation supporting licensed birth centers, though there are still only a few in the state. We haven’t had enough time yet to see the full impact of those changes, but we know the need for these providers is only going to grow. The Michigan Medicaid Agency recently published comment for coverage of home births and doulas. There’s also some policies around reimbursement for licensed midwives because they’re fee-for-service instead of under the regular Medicaid billing.”
Cross-Sector Collaboration
Tanesha: “MCMCH’s policy strategy includes collaboration with state government, stakeholders, and organizations across systems. What makes cross-sector collaboration successful when advocating for maternal health policy?”
Ta’Sheena: “We rely heavily on collaboration and cross-sector work to make sure we’re covering all the pieces and being intentional about including everyone who may be involved. Successful collaboration starts with recognizing that there are many different pathways and partners sometimes legislative, sometimes administrative, sometimes appropriations, sometimes a mixture, and you need people at the table who understand all of them. Our diverse roundtable of members, including clinicians and people with years of expertise we don’t have, is central to that. No single organization or sector has all the expertise needed to solve issues that are this complex and long-standing.
When it comes to agency work, identifying champions who can move an issue forward really matters and this can happen by leveraging relationships, expertise, and resources, and finding people who are motivated to advocate within their own sphere of influence. Successful collaboration means bringing the right people together around a shared goal, even when everyone approaches the work differently.
Community Voice
Tanesha: What are some examples of situations where community voices have challenged or changed the way policymakers or health systems approach maternal health?
Ta’Sheena: At the Council, we did a project supported by the W.K. Kellogg Foundation called Voices for Birth which was a second installation of our Birth Equity Education Project. When I first started at the Council as our birth equity and maternal health policy specialist, I did a lot of interviews with moms across Michigan, and Voices for Birth compiles those interviews alongside interviews with experts and Michigan programming addressing doulas, breastfeeding, mental health, and other cornerstone topics.
From those interviews we pulled themes around patient experience such as quality of care, communication of care, and decision-making in care. We also featured special populations like young families, people with disabilities, and folks navigating the justice system. Combining what moms, experts, and data were saying let us make very intentional and diverse policy recommendations. We hear all the time in this space that Black women aren’t being heard or listened to, so we wanted to know: What can we do better around communication of care and what programs in Michigan are already doing that well?
Our partners do a great job of keeping community voices at the table too. We’re involved in the Think Babies Michigan Coalition, which includes parent leaders so we’re constantly braiding families’ lived experience together with policy expertise and data to form intentional policy.
Rx Kids
Tanesha: Rx Kids provides financial assistance during pregnancy and infancy in high-need communities. How does direct financial support fit into a broader maternal health strategy?
Ta’Sheena: When families have what they need, they do better. Direct financial support gives families the ability to focus on their health, their baby’s health, and their recovery after birth, rather than constantly trying to figure out how to meet their basic needs. In Michigan, we don’t have paid leave, so it fills that gap too. Rx Kids is particularly powerful because it addresses the social and economic conditions that influence maternal and infant health. We’ve seen promising evidence around lower rates of low birth weight, eviction, and welfare involvement, and families showing up to prenatal appointments at higher rates.
Direct financial support is not a replacement for health care, home visiting, WIC, or other services, it’s another layer of support. Just like all of our programming in maternal and child health, Rx Kids is not the only answer, right? We need multiple solutions for our families and this is just another layer of support and solutions. If we want families to have healthy pregnancies and healthy babies, we have to address the medical care they receive. We have to look at families as whole people, not just when they walk into the hospital to give birth. We’ve seen a dramatic effect on the families who’ve been able to benefit from Rx Kids, which is a partner of MCMCH.
Accountability Beyond Bias Training
Tanesha: “MCMCH supports mandatory maternal and child health-specific implicit bias training as well as a reporting mechanism for biased or harmful healthcare incidents. What would meaningful accountability look like beyond simply requiring providers to complete bias training?”
Ta’Sheena: “Bias training is helpful, but we know that in the end, it can feel like something for providers to check off. Meaningful accountability means having mechanisms to understand when harm is happening, respond in real time, and make changes based on what patients and families are reporting. Training is an important tool, but completing it doesn’t tell us whether someone’s actual experience of care has changed.
If a patient or family experiences biased or harmful care, there should be a meaningful way to report that experience, have it reviewed, and identify patterns so that way we can require a response from the provider or hospital. If the pattern is repetitive, how can we truly address it or remove said person. This accountability piece is part of the Michigan Momnibus framework, and it’s currently moving through the legislature for a second time after not passing before. Requiring implicit bias training was one step forward. The next step is holding systems accountable for what they put onto families.”
Data and Disparities
Tanesha: “What types of data should Michigan be collecting or making more accessible to identify racial disparities and determine whether maternal health policies are actually improving outcomes?”
Ta’Sheena: “Michigan has already done a significant amount of maternal and child health data work, and we’ve made progress making that data useful for identifying disparities. We lean on the State Department of Health and Human Services’ dashboards and reports, and I think we do a good job cross-tabulating data by race, geography, and other indicators rather than relying on broad numbers alone. I think we could do a better job collecting and reporting data on Indigenous communities. That’s not unique to Michigan specifically. If we aren’t adequately capturing their experiences in our data systems, we can’t accurately understand the disparities or whether our policies are working for everyone — we know they’re dying at a very high rate too, compared to white women. Michigan’s PRAMS data, the Pregnancy Risk Assessment Monitoring System, is very valuable for us, and it oversamples, which helps us better understand different populations’ experiences.
PRAMS support was cut under this federal administration, so we’ve had to piecemeal it together with grants, but we should keep investing in systems like that and keep the information accessible. We have a strong relationship with our state PRAMS team, so we can ask for specific cross-tabulations, which is huge for us. At the same time, we have to give programs enough time to work. Michigan has made significant investments in maternal and child health, a lot of it thanks to Governor Whitmer’s tenure, and I’d like to see us sustain that level of investment while also increasing the variety of data we’re able to collect.”
Translating Quality Measures into Better Outcomes
Tanesha: “MCMCH is advocating for equitable care through quality and safety measures, including Michigan’s AIM bundles and the SOS Maternity Network. What have you learned about translating maternal health quality initiatives into meaningful improvements in the experiences and outcomes of birthing people?”
Ta’Sheena: “These are two separate initiatives, though families may experience both. What’s been exciting is watching evidence-based approaches play out in real time through the AIM bundles. We call them maternal quality payments, because hospitals have to implement the bundles and also register with the maternal levels of care system, which shows what resources they have for different intensities of care. Right now we have sepsis, hypertension, and hemorrhage bundles, and there was language in the recent FY27 budget signaling a substance use disorder bundle, with talk of a mental health bundle as well. In Michigan, those three conditions were among our highest indicators of morbidity and we’re able to drive those numbers down.
The lesson is that quality improvement has to translate to what’s actually happening at the bedside. People need to feel like they’re getting better care. Having evidence-based, standardized approaches matters, but implementation matters just as much. We need systems that can identify when care is falling short, support providers in making changes, and measure whether outcomes are improving. About 94% of our birthing hospitals have implemented or are committed to implementing the bundles for FY27. I believe we’re right behind California as one of the states with the highest implementation rate in the country.
SOS Maternity is a statewide program intervening earlier, through prenatal appointments in the OB office, before a family ever gets to the hospital. It uses simple evidence-based approaches, like measuring cervical length and giving aspirin during pregnancy to prevent complications. SOS Maternity is showing that those approaches lead to better outcomes. Through both initiatives (MI AIM bundle and SOS Maternity), the goal is the same, for the person giving birth to experience a safer, higher-quality birth, and the right acuity of care.”
What’s Vulnerable, and the Political Landscape
Tanesha: “With changes to Medicaid and the broader healthcare landscape, what maternal health policies do you think are most vulnerable right now, and where do you see opportunities for advocates to protect or strengthen them?”
Ta’Sheena: “Michigan’s legislature is divided with a Republican House, a Democratic Senate and a Democratic Governor. Much of the Michigan Momnibus package hasn’t moved — bills on accountability, data protection, and patient protections have stalled, though birth center licensing did pass. The one bill that did pass this session was the Doula Scholarship Fund, which grows the doula workforce directly through the Doula Advisory Council. We’re hopeful we can get more of the package passed before a lame duck session, because otherwise we’ll have to start over.
Our main goal right now is identifying bipartisan, bicameral champions, especially as some of our stronger champions get termed out*. There’s a lot of concern about Medicaid overall heading into FY28 budget planning. We’re more focused on sustaining the programs we have than on adding new ones right now, but there’s also real opportunity in this election cycle if the right champions step up.”
Looking Ahead
Tanesha: “If you could see one major maternal health policy change enacted in Michigan over the next five years, what would it be and what impact do you believe it could have on families and communities?”
Ta’Sheena: “That’s a loaded question. We say all the time to legislators that there is no single silver bullet, no single ask. There are multiple asks, right? We don’t want a slice, we want the whole pie. If I had to choose one slice, it would still be a big one: for Michigan to maintain and strengthen the progress we’ve already made. We’ve learned a lot about what families need and what evidence-based approaches actually work, and we shouldn’t lose ground on any of those investments.
Looking further out, I’d personally love to see Michigan enact paid maternal leave. There’s been momentum across the state and we’re involved in coalitions working on it, though it hasn’t moved much yet. Even Rx Kids has shown that when families have what they need, they do better and paid leave is one of those things. This could lead to families having more time to bond, access to lactation support, not rushing back to work, and catching up on vaccines for the baby and for yourself. Those pockets of time aren’t available to many Michigan families right now.
That’s the larger vision. Families with access to health care, to financial resources like Rx Kids — they have more time to spend together. Families need support not just to survive, but to thrive. We want to give families back some of the joy of pregnancy and birth.”
[*Editor’s Note: In Michigan, state legislators are limited to 12 years of combined service in either the House of Representatives or the Senate.]
[Ta’Sheena Williams is Policy Director at the Michigan Council for Maternal and Child Health (MCMCH).]