Like the rest of the nation, California is facing a maternal health crisis. Although California’s pregnancy-related mortality ratio—pregnancy-related deaths per 100,000 births— is lower than the national ratio, it has been rising in recent years, and the majority of these pregnancy-related deaths are preventable. California’s severe maternal morbidity (SMM) rate has also been rising and is higher than the national rate. Medi-Cal covers 40% of all births in California, and over 70% of pregnant and postpartum Medi-Cal members are enrolled in a Managed Care Plan (MCP).
The TMaH Model is aligned with and complementary to DHCS’ Birthing Care Pathway implementation. Lessons learned and evidence-based practices from TMaH may be scaled from the 5-county region to other parts of the state.
Model Details
Maternal Health Experience Transformation
TMaH Model will provide funding to transform the maternal health care experience in three key areas:
Maternal health educational resources and community partnerships to support greater access to valuable resources, such as midwives, doulas, and birth centers, as well as enhanced data collection and linkage to improve information sharing
| Quality initiatives and protocols with the goal of making childbirth safer and improving overall experience for mother and baby
| Comprehensive and risk-appropriate screening and referral protocols and increased coverage of care options to ensure that every mother receives care that is customized to meet their specific needs
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Transforming Maternal Health (TMaH) Model Maternal Health Care Team Factsheet
Pillars
The TMaH Model is composed of three pillars:
Access, Infrastructure and Workforce: The TMaH Model supports relationship building and education to help participating states address barriers that limit access to valuable resources, such as midwives, doulas, and community health workers (CHWs).
The TMaH Model is intended to promote care that is person-specific 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: The TMaH Model will facilitate implementation of quality initiatives and protocols with a goal of making childbirth safer and improving both the mother and baby’s overall experience. DHCS has partnerships with California Maternal Quality Care Collaborative (CMQCC) and the California Perinatal Quality Care Collaborative (CPQCC) to support implementation of “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 women living with substance use disorders.
Whole-Person care delivery: In the TMaH Model, every mother should receive customized care to meet their specific needs by supporting the development of a unique birth plan. Important tools that will be used include risk assessments and screening tools for perinatal mood and anxiety disorders, substance use, tobacco use, and health related social needs.
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. Patients may also be connected with community organizations or a community health worker depending on health-related social needs they may have.
The TMaH Payment Model
The VBP model will be developed by CMS and will be the same across all 15 TMaH-participating states. It will be implemented in three phases.
Starting in 2027, DHCS will allocate a portion of the TMaH funding to pay participating providers for care delivery transformation activities and improving data infrastructure to enable VBP model implementation. Guidance is forthcoming from CMS on these Provider Infrastructure Payments.
Starting in 2028, participating providers will be eligible for upside-only performance incentive payments. These payments will reward provider excellence on quality measures that align with model goals as well as achievement of cost benchmarks.
Starting in 2029, DHCS will work with Medi-Cal managed care plans to transition to a VBP model designed to incentivize the delivery of whole-person care that improves maternal health outcomes while maintaining or reducing Medicaid & CHIP program expenditures.
Ways to Get Involved
Join Our Stakeholder List
We will use this list to periodically disseminate information and updates about TMaH progress or opportunities for involvement, the Provider Infrastructure Payments and VBP model, and how to become a participating provider.
Provide feedback on the DRAFT Provider Participation Standards.
This document is an initial draft of requirements for providers to participate in the CA TMaH Model. We invite provider, managed care plan, and other stakeholder feedback on these draft standards via this email address: tmah@dhcs.ca.gov.
Materials
Relevant Webpages
Acknowledgement of Support
This program is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $17M with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.
