Transforming Maternal Health (TMaH) Model

On December 15, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the new Transforming Maternal Health (TMaH) Model. CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in Spring 2024. Applications will be due in Summer 2024.

TMaH is the newest CMS model designed to focus exclusively on improving maternal health care for people enrolled in Medicaid and Children's Health Insurance Program (CHIP). The model will support participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy. The goal of the model is to reduce disparities in access and treatment. The model aims to improve outcomes and experiences for mothers and their newborns, while also reducing overall program expenditures.

The model is projected to run for 10 years.

Model Overview

Despite spending more per capita on maternal health care than any other nation, the U.S. has disproportionately high rates of adverse pregnancy outcomes as compared to other high-income nations. The TMaH Model provides SMAs with targeted support in the form of funding and technical assistance. The goal of this support is to improve maternal health care and birth outcomes while reducing associated health disparities.  This support also enables states to develop a value-based alternative payment model for maternity care services which will improve quality and health outcomes and promote long term sustainability of services.

TMaH’s initiatives will center on three main pillars:

  • Access to care, infrastructure, and workforce capacity: TMaH will support relationship building and education to help participating states address barriers that limit access to valuable resources, such as midwives, doulas, and perinatal Community Health Workers (CHW). Greater access to these resources can have numerous benefits, including reduction in cesarian sections (c-sections) for low-risk pregnancies, shortened labor time, lower utilization of pain medication during birth, and lower rates of postpartum anxiety and depression. Participating SMAs will be able to promote care that is person-specific, culturally sensitive, and rooted in active listening and development of trust, with a goal of making mothers more empowered to manage their birth experience. 
  • Quality improvement and safety: Participating SMAs will implement quality initiatives and protocols with a goal of making childbirth safer and improving both the mother and baby’s overall experience. These evidence-informed interventions are called “patient safety bundles.” When implemented together and consistently, these protocols are shown to improve health outcomes across several clinical areas, including hypertension during pregnancy, cardiac conditions, and care for pregnant and postpartum people living with substance use disorders.  Participating SMAs will also work with their hospitals and health systems toward achieving the CMS “Birthing-Friendly” designation, which is the first federal quality designation with a focus on maternal health for hospitals and health systems. 
  • Whole-person care delivery: Pregnancy and birth are deeply personal experiences, and every person’s journey is unique. Under the TMaH Model, participating SMAs will strive to ensure that every mother receives care that is customized to meet their specific needs by supporting the development of a unique birth plan. Individuals will be screened during their initial prenatal visit to determine what, if any, additional supports they may need for health-related social needs, mental health, or substance use disorder.  Based on their physical, social, and mental health needs, a care plan will be developed in collaboration with the mother. Where appropriate, remote monitoring of conditions like hypertension and diabetes may be offered to reduce the burden of traveling to and from a doctor’s office. People may also be connected with community organizations or a community health worker depending on health-related social needs they may have.

Highlights

  • Women enrolled in Medicaid, including those in underserved communities and/or rural areas often experience significant disparities in maternal health care and poor health outcomes for themselves and their newborns.
  • TMaH will work with participating states to address gaps in maternal health care through activities like supporting access to midwives and doulas, improving prenatal care for chronic conditions like diabetes and hypertension, and reducing complicated procedures like c-sections for low-risk mothers.
  • TMaH will promote a more positive and supportive care experience and will allow mothers to play an active role in the development of their birth plan, and feel that their physical, mental health, and health-related social needs are met.
  • All participating state Medicaid agencies will develop and implement a health equity plan that addresses disparities among underserved populations. Participating state Medicaid agencies will also support the extension of Medicaid and CHIP postpartum coverage to 12 months to promote preventive care, overall health, and reduction of care costs.

Model Design

TMah Model Journey map, showing the progression of patient Jaya's pregnancy journey, from prenatal care through birth and postpartum care
(PDF)

Model Phases: 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.

Model Participation: TMaH is a state-based model, in which state Medicaid agencies serve as model awardees. Along with state Medicaid agencies, Managed Care Organizations (MCOs), Perinatal Quality Collaboratives, hospitals, birth centers, health centers and rural health clinics, maternity care providers and community-based organizations are critical collaborators to model success.

Another component of TMaH’s approach to promoting person-centered care includes expanded access to diverse types of maternity care providers, such as midwives as well as doulas, who provide non-clinical support and guidance. CMS will issue Cooperative Agreements to up to 15 state Medicaid agencies.

Pillar I. Access, Infrastructure, and Workforce

ProblemModel Solution
Limited access to the full range of maternal health care providers
  • Increase access to birth centers and midwives
Limited access to community-based maternity services
  •  Increase access to perinatal community health workers and doulas
Outdated data collection methods; limited information-sharing among providers, Community Based Organizations (CBOs), and other agencies
  • Enhance data collection, exchange, and linkage through improvements in electronic health records and health information exchanges
     

Pillar II. Quality Improvement and Safety

ProblemModel Solution
Lack of evidence-informed safety practices in hospitals (e.g., low-risk c-sections)
  • Implement “patient safety bundles,” or specific protocols that promote the reduction of avoidable procedures, leading to improved outcomes
  • Promote achieving “Birthing-Friendly” designation
  • Introduce option to promote shared decision-making between mothers and providers

Pillar III. Whole-Person Care Delivery

ProblemModel Solution

A “one size fits all” approach to care to manage medical complications that is not personalized to optimize overall health and wellness 

 

 

 

  • Institute evidence-based medical and social risk assessment to drive risk-appropriate care
  • Deliver care consistent with individual preferences
Inconsistent medical risk screenings for conditions such as depression
  • Routinely screen and follow-up for perinatal depression, anxiety, tobacco and substance use during prenatal and postpartum periods 
  • Incorporate home monitoring and telehealth technology for birthing people who have medical conditions like gestational diabetes and hypertension that complicate pregnancies
Inconsistent screenings for health-related social needs (HRSNs) and HRSNs not addressed as part of the care plan
  • Routinely screen and follow-up for HRSNs
  • Establish reliable referral pathways to and from community-based organizations to address HRSNs
Disparities, including racial and ethnic disparities, and lack of cultural competency training for providers, making people feel like their concerns are ignored
  • Develop and implement Health Equity Plans as well as cultural competency technical assistance for providers

Health Equity Strategy

TMaH includes a health equity strategy to address disparities among underserved populations, such as racial and ethnic groups and people living in rural areas, who are at higher risk for poor maternal outcomes. The model will also encourage participating states to extend Medicaid and CHIP postpartum coverage to 12 months to promote preventive care, overall health, and reduction of care costs.

TMaH will offer tailored, state-specific technical assistance to support providers and other partners in rural, Tribal, or other high-need areas. This assistance may include establishing regional partnerships and receiving guidance for including Federally Qualified Health Centers (FQHCs) and rural health centers in the care delivery and payment model.

Technical assistance will also focus on increasing providers’ capabilities to screen for health-related social needs (HRSNs), refer to community-based and social services, and track how individual needs are addressed. Referrals for identified HRSNs, including housing, transportation, and food, may improve health outcomes and reduce avoidable and more costly interventions in the future. Additional technical assistance will be provided to help states develop a Health Equity Plan.

Health Equity Plans: SMAs participating in the model will be required to develop and implement a Health Equity Plan unique to their specific population. States must consider language support for non-native English speakers, access to transportation services, and improvements to address gaps in care.

What's Next?

CMS will release a Notice of Funding Opportunity (NOFO) in Spring 2024, and the application will be due in Summer 2024. Applications will be reviewed by a panel of technical experts.

Past Events

Additional Information

Outreach

If you have questions regarding the Transforming Maternal Health Model, you can contact the TMaH Model team at: TMAHModel@cms.hhs.gov

Sign up for the TMaH Model listserv to receive email updates about the model.

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