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California Transforming Maternal Health

In January 2025, the Centers for Medicare and Medicaid (CMS) Innovation Center announced that California was among the 15 states selected to participate in the Transforming Maternal Health (TMaH) Model, a Medicaid and Children’s Health Insurance Program (CHIP) delivery and payment model designed to test whether effective implementation of evidence-informed interventions, sustained by a value-based payment (VBP) model, can improve maternal health outcomes and reduce Medicaid and CHIP program costs. CMS awarded DHCS $17 million in federal funding to plan and implement the TMaH Model over ten years in a 5-county region in the Central Valley including Fresno, Kern, Kings, Madera and Tulare Counties.

During the first three years (the Pre-Implementation Period), DHCS will receive technical assistance to advance each model element and achieve CMS-required pre-implementation milestones. Subsequently, there will be a 7-year Implementation Period when the VBP model will be utilized.

Context

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:

Access to Care, Infrastructure, and Workforce	Quality Improvement and Safety	Whole-Person Care Delivery
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

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.

TMaH Accountable Entity Application – Due 11.18.26

The Department of Health Care Services (DHCS) is asking eligible Medi-Cal-enrolled clinical perinatal providers in TMaH Model counties (Fresno, Kern, Kings, Madera, and Tulare) that are interested in participating in the California Transforming Maternal Health (TMaH) Model to complete the TMaH Model Accountable Entity (AE) Application by Wednesday, November 18th.

CMS has defined the participating unit in the TMaH Model to be an “Accountable Entity” (AE). AEs may be one provider organization or multiple provider organizations in a contractual arrangement that deliver the full range of clinical maternity services including prenatal, labor and delivery, and postpartum (“perinatal”) care and agree to be accountable for cost and quality outcomes under the TMaH Model. Provider organizations must meet the requirements in all categories to be eligible as an AE: 

Legal Requirements

Be a legal entity formed under applicable state, federal, or Tribal law and authorized to conduct business in CA

Be Medi-Cal-enrolled with an active TIN and organizational Medi-Cal Billing National Provider Identifier (NPI)

Service Provision Requirements

Provide the full range of perinatal care – prenatal, delivery, and postpartum care – which could be provided among different organizations within the AE
Employ or contract with providers who bill for prenatal, postpartum, and delivery services (demonstrated by submitting claims with the appropriate codes)
Bill under qualifying maternity care specialty types*
Collectively perform at least 30 Medi-Cal-covered deliveries annually among Medi-Cal Managed Care Members in Fresno, Kern, Kings, Madera, or Tulare counties

Contractual Requirements

Comply with applicable model requirements, such as data and reporting requirements, and participate in performance measurement and financial reconciliation
Participate in technical assistance activities

*The following types of clinical providers/practices can participate in the TMaH Model as AEs if they meet AE eligibility criteria: Obstetrics and Gynecology Physician (OB/GYN); Maternal-Fetal Medicine physician (MFM); Certified Nurse Midwife (CNM); Licensed Midwife (LM); Obstetric Nurse Practitioner; Women’s Health Nurse Practitioner Family Medicine; Family and Adult Nurse Practitioners (NP); Federally Qualified Health Center (FQHC) or FQHC Look-Alike providing perinatal services; Tribal Health Center and Indian Health Service (IHS) facility providing perinatal services. This list is subject to change.

Application Link: California Transforming Maternal Health (TMaH) Model Accountable Entity (AE) Application

Application Instructions: Each organization should submit only one application. Responses cannot be saved for you to return to later, so please complete the application in one session without exiting the Smartsheet webpage.

The AE Application is the next step for provider organizations interested in participating in the TMaH Model. Responses will help DHCS understand provider organizations’ qualifications for participating in the TMaH Model, potential AE structures, readiness to meet TMaH Model requirements, and infrastructure needs that may support successful implementation. Completing this application does not require or bind organizations to become an AE, enter into a contractual arrangement, or make a final commitment to participate in the TMaH Model.

Ways to Get Invloved

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.

Contact Us at 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.