The Centers for Medicare and Medicaid Services is offering states money to test Medicaid initiatives designed to tackle the maternal health crisis, the agency announced Friday.
CMS will provide up to $17 million over 10 years to as many as 15 states to establish what CMS describes as a holistic approach to childbirth and postpartum care that addresses patients' physical, mental and social needs. Medicaid covers about 40% of childbirths.
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The Transforming Maternal Health program aligns with other recent federal and state efforts aiming to reverse worsening maternal health outcomes. The maternal mortality rate was 32.9 deaths per 100,000 live births in 2021, compared with 23.8 in 2020 and 20.1 in 2019, according to the Centers for Disease Control and Prevention.
Those outcomes are among the worst in the developed world and reflect stark racial inequities. Black women, for example, are 2.6 times more likely to die during childbirth than non-Hispanic white women, according to the American Medical Association.
CMS seeks to encourage states to improve care from pregnancy through the postpartum period by facilitating access to complementary providers such as midwives, doulas and social workers, and by licensing birthing centers, particularly in rural and low-income areas struggling to sustain labor and delivery services. The agency also aims to reduce low-risk cesarean sections.
States accepting the CMS funds will have to establish screening programs for social risk factors such as nutrition, housing and substance use, and to connect beneficiaries to community-based resources. Participating states must create health equity plans and extend Medicaid and Children's Health Insurance Program coverage to 12 months following birth. States will be required to assist hospitals with achieving “birthing-friendly” designations from CMS.
States may also collaborate with health insurance companies that administer Medicaid to develop alternative maternity care payment models that employ technology such as in-home monitoring of high-risk pregnant patients.