TMaH (Transforming Maternal Health) Model

The Transforming Maternal Health (TMaH) Model supports participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care. By addressing the physical, mental health, and social needs experienced during pregnancy, the model aims to improve outcomes and experiences for mothers and babies, while also reducing overall program expenditures.

The TMaH Model is voluntary and will run for 10 years (2025-2034).

Key Points
Problem: The United States has one of the highest maternal mortality rates among high-income countries which disproportionately impacts Medicaid populations. Solution: The model supports state Medicaid agencies and holds them accountable to implement evidence-based strategies for expanding access to maternal care, while also integrating behavioral health, social drivers of health, and continuity of care in the postpartum period, including building a bridge between clinical and community-based care. Outcomes: The model aims to improve maternal and infant health outcomes, such as reduce rates of low-risk cesarean section (c-section), severe maternal morbidity (SMM), and incidence of low birthweight infants and improve overall care experiences for pregnant women. Strategy: The model aligns with CMMI strategy to promote preventive care by increasing engagement in prenatal and post-partum care, expanding the perinatal health care team, and screening for and managing co-morbidities, as well as empowering patients by increasing their access to health information through technology and data, telehealth, and home monitoring.

Key Points

Problem: The United States has one of the highest maternal mortality rates among high-income countries which disproportionately impacts Medicaid populations.
Solution: The model supports state Medicaid agencies and holds them accountable to implement evidence-based strategies for expanding access to maternal care, while also integrating behavioral health, social drivers of health, and continuity of care in the postpartum period, including building a bridge between clinical and community-based care.
Outcomes: The model aims to improve maternal and infant health outcomes, such as reduce rates of low-risk cesarean section (c-section), severe maternal morbidity (SMM), and incidence of low birthweight infants and improve overall care experiences for pregnant women.
Strategy: The model aligns with CMMI strategy to promote preventive care by increasing engagement in prenatal and post-partum care, expanding the perinatal health care team, and screening for and managing co-morbidities, as well as empowering patients by increasing their access to health information through technology and data, telehealth, and home monitoring.

Model Details

Background

The TMaH Model builds on lessons learned from previous CMS maternal health initiatives, including the Maternal Opioid Misuse (MOM) Model. TMaH is the first Innovation Center model focused exclusively on maternal health care.

TMaH Model Journey Map: Jaya's Pregnancy Journey with TMaH (PDF)

Aims

The TMaH Model provides participating state Medicaid agencies with cooperative funding to support implementation of evidence-based interventions to:

Improve maternal health outcomes and patient experiences at the state level for mothers and babies covered by Medicaid and the Children’s Health Insurance Program (CHIP)
Expand access to midwives and doulas, improve prenatal care for chronic conditions like diabetes and hypertension, and reduce complicated procedures like c-sections for low-risk mothers
Foster a positive, supportive care experience that allows mothers to play an active role in the development of their birth plan and postpartum care

Innovation

The TMaH Model promotes state Medicaid agencies accountability for maternal health quality and outcomes and integrates behavioral health and substance use disorder services into regular maternal and postpartum care. Additionally, by expanding access to services like doulas, midwives, and community health workers, the model can provide enhanced, whole-person postpartum coverage and continuity of care for new mothers and their babies.

Design

The TMaH Model design centers on three components:

Access, Infrastructure, and Workforce
- Increase access to birth centers and midwives
- Increase access to community health workers and doulas
- Enhance data collection
Quality Improvement and Safety
- Reduce avoidable procedures like c-sections for low-risk mothers
- Promote shared decision-making between mothers and providers
Whole-Person Care Delivery
- Institute evidence-based medical and social risk assessments
- Promote risk-appropriate care
- Screen for depression, anxiety, and substance use during prenatal and postpartum periods
- Promote telehealth for conditions like gestational diabetes and hypertension that can cause complications in pregnancy

Participant Information

The TMaH Model is a state-based model, in which state Medicaid agencies serve as model participants who collaborate with Managed Care Organizations, Perinatal Quality Collaboratives, hospitals, birth centers, health centers and rural health clinics, maternity care providers and community-based organizations to ensure model success. The selected states are eligible to receive up to $17 million in cooperative agreement funding to support implementation activities as well as technical assistance from CMS.

In January 2025, CMS announced that the following states had been selected to participate in the model:

Alabama

Arkansas

California

District of Columbia

Illinois

Kansas

Louisiana

Maine

Minnesota

Mississippi

New Jersey

Oklahoma

South Carolina

West Virginia

Wisconsin

The model has a 3-year pre-implementation period, during which states receive targeted technical assistance to advance each model element and achieve required pre-implementation milestones, and a 7-year implementation period to execute the model.

Additional Information

Events Archive

For CMS Innovation Center updates, including about TMaH, subscribe to the CMS Innovation Center listserv.
For additional information and updates specifically about TMaH, please subscribe to the TMaH Model Listserv
Contact the model team at TMaHModel@cms.hhs.gov.

Visit our Innovation Model webpage for a list all CMS Innovation Center model tests.