Alert

The Centers for Medicare & Medicaid Services (CMS) announced the Transforming Maternal Health (TMaH) Model awardees on January 6, 2025. This 10-year payment model focuses on improving maternal health care for Medicaid and Childrens Health Insurance Program (CHIP) beneficiaries in 15 selected states while simultaneously lowering overall program costs.

TMaH provides funding to support each State Medicaid Agency (SMA) in creating and implementing an all-encompassing, whole-person strategy to provide pregnancy, childbirth, and postpartum care for eligible patients.

The program began on January 1, 2025, and runs until December 31, 2034.

The new payment model aims to improve outcomes and experiences for mothers and their newborns by:

• Enhancing the quality of care and patient experience for pregnant and postpartum individuals
• Reducing the incidence of preventable adverse outcomes, including severe maternal morbidity and mortality
• Reducing the prevalence of low-risk cesarean sections and low birthweight infants
• Improving access to midwifery and doula services

Explore the new payment model’s details and how it can impact your health care organization with the following insights.

Model Location and Participants

TMaH is administered through SMAs, serving as the model awardees. The SMA may designate the whole state or a sub-state region to participate in TMaH. Each selected SMA is eligible to receive up to $17 million in Cooperative Agreement funding over the course of the 10-year program.

CMS selected the following 15 states and sub-state regions to participate in TMaH:

• Alabama
• Arkansas
• California – Fresno, Kern, Kings, Madera, and Tulare Counties
• District of Columbia
• Illinois – Aurora and Rockford
• Kansas
• Louisiana
• Maine
• Minnesota
• Mississippi
• New Jersey
• Oklahoma
• South Carolina
• West Virginia
• Wisconsin

SMAs can collaborate with Managed Care Entities (MCEs) as applicable, to create a plan for model participation. This may include collaboration around best practices and performance improvement strategies.

SMAs and MCEs may also coordinate with maternity care providers such as:

• Hospitals
• Birth centers
• OB-GYNs
• Midwives
• Doulas
• Community health workers
• Social workers
• Lactation consultants
• Behavioral health specialists
• Rural Health Clinics (RHCs)
• Federally Qualified Health Centers (FQHCs)
• Tribal sites
• Community-based organizations (CBOs)

To take part in TMaH, the provider types must be recognized by their SMA.

Model Goals

TMaH is intended to promote a whole-person care approach that addresses physical and mental health, and social needs during pregnancy, childbirth, and postpartum periods. CMS will create and manage a learning system to help SMAs, their MCEs, and provider partners share information and insights as they prepare to meet model requirements.

TMaH aims to transform the maternal health care experience across three domains:

Access to Care, Infrastructure, and Workforce Capacity

Key initiatives include:

• Enhancing data infrastructure
• Increasing access to midwives and birth centers
• Providing coverage for licensed midwives and doulas
• Optionally covering perinatal community health workers
• Creating rural regional partnerships

Quality Improvement and Safety

• Participating SMAs will implement evidence-based patient safety bundles, focusing on areas such as pregnancy-related hypertension, cardiac conditions, and substance use disorders.
• SMAs will collaborate with hospitals and health systems to achieve the CMS Birthing-Friendly designation.
• Optional initiatives include promoting shared decision-making to enhance patient involvement in care.

Whole-Person Care Delivery

Provider participants will be expected to deliver a risk assessment for perinatal depression, anxiety, tobacco use, substance use disorder, and health-related social needs, and offer referrals and follow-up care, as relevant. Providers will be encouraged to offer remote monitoring for chronic conditions such as diabetes and hypertension.

Care will be personalized through the creation of collaborative, individualized birth plans, with screening at the initial prenatal visit to identify additional support needs.

Optional efforts may include:

• Expanding group perinatal care
• Increasing home visits
• Mobile clinics
• Telehealth services
• Oral health care

Connecting individuals to community resources and health workers to address social determinants of health is also encouraged.

TMaH was originally published with a health equity strategy under the Biden administration. Given the directives of the Trump administration, the strategy is likely to be renamed or removed from TMaH.

In the meantime, CMS:

• Requires each participating SMA to develop a Health Equity Plan to address disparities among underserved populations.
• Encourages extending Medicaid and CHIP postpartum coverage to 12 months to promote preventive care and overall health.
• Provides technical assistance to support rural, Tribal, or other high-need areas.

Model Timeline and Payment Design

TMaH has a three-year pre-implementation period, during which SMAs will receive technical assistance to address each model element and achieve readiness milestones, including planning for the implementation period. After this, SMAs execute the model activities during a seven-year implementation period.

During the implementation period, SMAs will provide infrastructure payments to participating health care providers, to support care delivery transformation and data infrastructure. Each SMA will develop a value-based alternative payment model that incentivizes providers to deliver high-quality, cost-effective maternity care services.

Pre-Implementation Period

During Model Years (MY) 1-3 (2025-2027) SMAs will:

• Identify MCEs, if applicable, maternal health providers, and CBOs eligible to receive technical assistance and infrastructure funding from TMaH.
• Receive tailored technical assistance from TMaH policy and analytic experts. A Technical Assistance Plan will be drafted collaboratively between the SMA, CMS Innovation Center, and a contracted coach.
• Distribute infrastructure payments to provider participants starting in MY 3.
• Submit quarterly reports to CMS outlining progress on model implementation and specific operational activities.

Implementation Period

MY 4-10 (2028-2034), SMAs will implement a value-based alternative payment model for maternal care providers.

In MY 4, maternal care providers can receive upside-only incentive payments if they meet quality and patient safety measure goals and achieve a cost benchmark. Providers will receive Quality and Cost Performance Incentive Payments (PIP) based on the MY 4 performance. PIP amounts will be based on an aggregate quality performance score and cost performance score, weighted 80% and 20%, respectively.

The quality measures used to determine PIPs will be finalized by the end of MY 3. Proposed quality measures include:

• Low-risk cesarean deliveries
• Maternal depression screenings and follow-ups
• Severe obstetric complications
• Timeliness of prenatal and postpartum care

Starting in MY 5, SMAs will begin to implement the state-specific, value-based alternative payment model, shifting away from status quo payments and the TMaH PIP that began in MY4. The value-based payment model will reward those who reduce excessive Medicaid and CHIP program expenditures.

CMS and SMAs will engage the recipients and key stakeholders in decisions related to the payment approach.

Next Steps

Maternal care providers located in one of the 15 selected locations should look for forthcoming information from their State Medicaid Agency, and may wish to subscribe to the agency’s or CMS' listserv.

We’re Here to Help

For more insights on value-based care and other payment models, contact your firm professional.

Additional Resources

• Health Care Consulting Services
• Health Care Practice