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Maternal & Infant Health Care Quality

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 to pregnant and postpartum women. The Maternal and Infant Health (MIH) Beneficiary Profile provides an overview of the demographics, health status, health outcomes, risk factors, and health care utilization among reproductive age women, women with a recent live birth, and infants covered by Medicaid and CHIP. As the MIH Beneficiary Profile illustrates, CMS is in a unique position to improve perinatal outcomes and reduce disparities through quality improvement and measurement and supporting value based care.

Maternal and Infant Health Initiative

To improve access to and quality of care for pregnant and postpartum women 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 women 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):

  1. Increase the use and quality of postpartum care visits;
  2. Increase the use and quality of well-child visits; and
  3. 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)