Nearly two out of every three adult women enrolled in Medicaid are in their reproductive years (ages 19-44), and Medicaid currently finances about 42% of all births in the United States.1 The Centers for Medicare & Medicaid Services (CMS) can play a major role in improving the quality of maternity care, birth outcomes and in measuring how care is delivered during pregnancy and postpartum. The Maternal Health Infographic provides a snapshot of demographics, health outcomes, risk factors, access and utilization, and disparities among beneficiaries seeking pregnancy-related care and those with a recent live birth. As the maternal health infographic illustrates, CMS is in a unique position to improve perinatal outcomes and equity through quality improvement and measurement and by supporting value-based care.
What’s New in the Maternal and Infant Health Initiative
Beginning in May 2024, the Maternal and Infant Health Initiative (MIHI) launched a new webinar series to be followed by two affinity groups focused on two of the main drivers of poor maternal health outcomes, “Addressing Maternal Mental Health and Substance Use” and “Improving Maternal Hypertension Control.” Maternal mental illness is the leading cause of pregnancy-related deaths in the U.S.2 Substance use during pregnancy, such as alcohol, tobacco, opioids and marijuana, places the birthing person and the fetus at risk.3 Uncontrolled high blood pressure (hypertension), both common and preventable, contributes to adverse outcomes and death before, during, and after pregnancy and decades later.4 Black, Hispanic/Latina(x) and American Indian/ Alaska Native (AI/AN) communities are disproportionately impacted; maternal mortality and severe maternal morbidity rates are two to three times higher among Black and AI/AN individuals compared to white individuals.5 As the largest public payer of births nationwide,6 Medicaid and CHIP programs have a significant role in enhancing systems of care to improve maternal health, reduce preventable maternal mortality and severe maternal morbidity, and support equitable outcomes for all.
The webinar series (described below) will conclude in August of 2024 and will focus on the challenges during the pregnancy and postpartum period related to addressing their mental health, substance use, and hypertension management. CMS invites all interested staff from state Medicaid and CHIP agencies, along with their hospital and obstetrical providers, Medicaid and CHIP managed care plans, public health agencies, and other quality improvement partners, to take part in the summer 2024 maternal health webinar series. To register for one or more of the webinars, click here.
Maternal Health Summer 2024 Webinar Series
Webinar #1: Promoting Maternal Health Improvement and Equity Through Collaboration, May 14, 2024 (slides, video, transcript)
As the single largest payer of pregnancy-related services, state Medicaid and CHIP agencies have an important role to play in enhancing access to high quality care and improving maternal health outcomes. In May 2024, CMS held this webinar to outline a multilevel framework for leveraging Medicaid, systems of care, technology, and community-based partners to improve health equity and outcomes. Experts describe strategies to promote collaboration across the maternal health ecosystem and state presenters share the successful experiences building partnerships to address outcomes.
Webinar #2: Maternal Mental Health Screening, Treatment and Improvement Strategies, June 4, 2024 (slides, video, transcript)
Undiagnosed and undertreated mental health challenges are among the leading contributors of maternal mortality. This webinar reviews clinical guidelines for perinatal and postpartum mental health screening that improve early detection, diagnosis, and treatment, as well as management of pre-existing mental health conditions during pregnancy. Experts, Medicaid and CHIP agencies, and partners present strategies to promote behavioral health integration, technologies, and other supports to improve provider capacity and access to address maternal mental health.
Webinar #3: Decreasing Fragmentation in Maternal Substance Use Disorder Screening and Treatment, June 25, 2024 (slides, video, transcript).
Substance use is a leading cause of pregnancy-related death and adverse birth outcomes. Provider and health systems capacity for treatment are often fragmented or unavailable to pregnant women covered by Medicaid and CHIP. This webinar outlines strategies to reduce fragmentation in SUD screening, referral, tracking, and treatment by improving clinical care coordination and integrating behavioral health services and supports. State presentations feature strategies that engage communities, expand workforce, and promote collaboration collaborating across systems.
Webinar #4: Addressing Hypertension Before, During and After Pregnancy, July 16, 2024 (slides, video, transcript)
High blood pressure, also known as hypertension, is common, preventable, and treatable. When untreated, the impacts can have lifelong health consequences. New recommendations advise screening and treatment during preconception, pregnancy and postpartum. During this webinar, experts and states present strategies for Medicaid and CHIP agencies to improve screening, treatment, and care coordination.
Webinar #5: Medicaid and CHIP Program Collaboration with Hospitals on AIM Bundles, August 20, 2024 (slides, video, transcript)
The Alliance for Innovation on Maternal Health (AIM) is a national, cross-sector project leading the identification, development, implementation, and dissemination of maternal health patient safety bundles. AIM safety bundles are hospital and community-based practices that improve the quality of care provided during delivery and in the postpartum period. During this webinar, attendees hear from Medicaid and CHIP programs and AIM partners about supporting these evidence-based practices to better manage high-risk care and address systemic inequities in regions with poor maternal health outcomes.
Affinity Groups
Beginning in fall 2024, CMS will convene two affinity groups focused on: 1. addressing maternal mental health and substance use and 2. improving maternal hypertension and cardiovascular health. State teams, led by Medicaid or CHIP program staff, may consider joining this action-oriented affinity group to learn through workshops and one-on-one coaching, and work alongside peers focused on improvement projects in their states. States interested in joining the one or both affinity groups must complete an Expression of Interest (EOI) form. When completing the EOI, please indicate which affinity group you are interested in; you may also indicate an interest in both. Note: It is not necessary to indicate a specific improvement focus or identify QI partners at this time as project development will be supported during the first 3 months of the affinity group. To learn more about these affinity groups, please attend the Informational Webinar.
Informational Webinar: Overview of the “Addressing Maternal Mental Health and Substance Use” and “Improving Maternal Hypertension Control” Affinity Groups and the Expression-of-Interest Process, September 17, 2024- Video Recording, (slides)
Expression of Interest: to fill out the EOI, click here.
Expression of Interest forms are due by October 4, 2024.
For more information please see the Maternal Mental Health and SUD webpage and Maternal Hypertension and Cardiovascular Health webpage.
History of the Maternal and Infant Health Initiative
To improve access to and quality of care during the pregnancy and postpartum periods, and their infants, CMS launched the Maternal and Infant Health Initiative (MIHI) in July 2014. The MIHI was built on the foundation laid by CMS’s Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and Children's Health Insurance Program (CHIP) and the input of a wide range of stakeholders on recommended strategies. In light of recommendations from the Maternal and Infant Health Expert Panel, the MIHI initially focused on improving the rate and quality of postpartum visits and increasing the use of effective methods of contraception among beneficiaries in Medicaid and CHIP through a variety of technical assistance offerings for state Medicaid and CHIP Agencies including webinars, learning collaboratives, and issue briefs.
Five years into the MIHI and in light of increasing rates of maternal and infant mortality and morbidity, CMS identified a need to take stock of the progress of the MIHI and to chart a course for the next five years. To inform CMS in this process, another expert workgroup was convened comprised of new and returning members of the original Expert Panel, representing a variety of stakeholders including providers, health plans, quality collaboratives, state Medicaid agencies, and other federal partners. The workgroup helped to identify and prioritize three areas of focus where Medicaid and CHIP have a significant opportunity to influence change through technical assistance (TA):
- Increase the use and quality of postpartum care visits;
- Increase the use and quality of well-child visits; and
- Decrease the rates of cesarean section births in low-risk pregnancies, defined as nulliparous (first-time pregnancies), term (37 or more weeks gestation), singleton (one fetus), vertex (head facing down in the birth canal) or “NTSV births.”
The Expert Workgroup emphasized the need for a comprehensive life-course approach to maternal and infant health, one that recognizes the importance of the mother-infant dyad as well as the inter-connectedness of the focus areas and how they affect both maternal and infant health outcomes throughout the childbearing years as well as infancy and early childhood. Read the full report of the Expert Workgroup recommendations.
[1] National Center for Health Statistics. Key Birth Statistics (2018 data, released 2019)
[2] JAMA Psychiatry. Published online February 21, 2024.
[3] NIDA. "Substance Use While Pregnant and Breastfeeding." National Institute on Drug Abuse, 18 Jan. 2024.
[4] Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization — United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2022;71:585–591.
[5] CDC. “Working Together to Reduce Black Maternal Mortality.” Center for Disease Control and Prevention, January 2, 2024.
[6] Valenzuela CP, Osterman MJK. Characteristics of mothers by source of payment for the delivery: United States, 2021. NCHS Data Brief, no 468. Hyattsville, MD: National Center for Health Statistics.