Transforming Maternal Health Model: What Medicaid MCOs Need to Know
On January 6, 2025, CMS announced the states selected to participate in the Transforming Maternal Health (TMaH) Model, a 10-year initiative designed to improve maternal health outcomes for Medicaid and CHIP beneficiaries. This model focuses on addressing disparities in maternal health care by providing targeted support to state Medicaid agencies (SMAs) in the form of funding and technical assistance.
TMaH Model Overview:
The TMaH Model seeks to transform maternity care through three core pillars:
Access to Care, Infrastructure, and Workforce Capacity: The model aims to expand access to midwives, doulas, and perinatal community health workers (CHWs), particularly in underserved communities. This is essential for reducing complications like unnecessary C-sections and improving overall birth outcomes.
Quality Improvement and Safety: Participating states will implement evidence-based protocols known as "patient safety bundles" to improve care safety and reduce avoidable procedures. Additionally, hospitals will work toward achieving the CMS "Birthing-Friendly" designation, a federal quality standard for maternal health.
Whole-Person Care Delivery: The model emphasizes personalized care that addresses the physical, mental, and social needs of pregnant individuals. This includes comprehensive screenings for conditions like perinatal depression, diabetes, and hypertension, and providing care that is culturally competent, and patient centered.
States Selected for TMaH Model:
The following states and the District of Columbia have been selected to participate in the TMaH Model: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Louisiana, Maryland, Michigan, Missouri, New Jersey, New York, and Washington, D.C.
Health Equity Strategy:
A key component of TMaH is its health equity strategy, which aims to reduce disparities among underserved populations, particularly racial and ethnic minorities and individuals living in rural areas. MCOs will collaborate with state Medicaid agencies to develop Health Equity Plans that address these disparities. These plans will include strategies for extending Medicaid and CHIP postpartum coverage to 12 months, ensuring continuous care and better health outcomes for mothers and their newborns.
What MCOs Should Do:
Integrate TMaH into Care Models: MCOs must incorporate the TMaH initiatives into their existing care models, ensuring that maternal health services are comprehensive and accessible. This includes expanding networks to include midwives, doulas, and other non-traditional providers.
Focus on Value-Based Payment Models: MCOs will need to work with state Medicaid agencies to establish value-based payment models that reward improved outcomes, such as lower rates of preterm births and reduced maternal mortality.
Address Health-Related Social Needs: MCOs should support providers in screening for and addressing health-related social needs (HRSNs), such as housing, transportation, and food security. These factors are crucial for improving maternal health outcomes, particularly in underserved communities.
Conclusion:
The TMaH Model presents an exciting opportunity for Medicaid MCOs to contribute to a long-term transformation in maternal health care. By focusing on access to care, quality improvement, and whole-person care delivery, MCOs can help reduce disparities and improve outcomes for pregnant individuals and babies. This initiative aligns with broader healthcare reforms aimed at reducing costs while improving care quality, making it a win-win for both beneficiaries and the healthcare system. Agilian is here to support MCOs in navigating these changes and optimizing care models to ensure better health outcomes for Medicaid beneficiaries.
For more information on the TMaH Model, visit: