​             CALIFORNIA SELECTED FOR NEW      ​ MEDI-CAL INITIATIVE TO IMPROVE MATERNAL HEALTH AND ADVANCE BIRTH EQUITY

$17 Million in Funding Will Support Five Central Valley Counties Over 10 Years

 
SACRAMENTO — The California Department of Health Care Services (DHCS) has been selected by the Centers for Medicare & Medicaid Services (CMS) to implement its Transforming Maternal Health (TMaH) Model, a 10-year Medicaid and Children's Health Insurance Program (CHIP) delivery and payment model designed to improve maternal health outcomes and reduce health care expenditures through a whole-person approach to pregnancy, childbirth, and postpartum care. California is one of 15 states selected to participate in the TMaH Model.

The TMaH Model will implement evidence-informed interventions within a value-based payment (VBP) framework, reimbursing providers based on patient health outcomes and quality of care, rather than the volume of services provided. By focusing on improving maternal outcomes, reducing costs, and enhancing the quality of care, the model aims to reduce low-risk cesareans, lower severe maternal morbidity, and increase access to maternal providers, such as midwives, doulas, and birth centers, for Medi-Cal members.

This initiative will improve the state's maternal care system, particularly for pregnant Medi-Cal members and their infants, who traditionally experience disparities in maternal health care access and outcomes. The TMaH Model will focus on areas with the greatest need for intervention and resources. DHCS will implement the TMaH Model in five Central Valley counties: Fresno, Kern, Kings, Madera, and Tulare.

"By targeting these high-need counties, we are taking a strategic step toward improving the health and well-being of pregnant people across California, particularly in areas experiencing the greatest maternal health disparities," said DHCS Director Michelle Baass. "This model will allow us to test innovative approaches to maternal health care, ensuring that every pregnant Medi-Cal member, regardless of their background or circumstances, receives the care they need to have a healthy pregnancy and delivery. Participation in TMaH will advance DHCS' ability to achieve its maternal health priorities and continue investing in the future of equitable birthing care."

"TMaH offers a meaningful opportunity to reduce maternal health disparities by increasing access to doulas and midwives in our communities," said Shantay R. Davies-Balch, President and Chief Executive Officer of Belonging, Love, Affinity, Community, & Kinship (BLACK) Wellness & Prosperity Center. “These professionals are vital advocates for families, providing personalized care and a holistic approach to both prenatal and postpartum support."

“The CMS Transforming Maternal Health grant strengthens California's leadership and innovation while taking a crucial step toward reducing health disparities and ensuring mothers in the Central Valley have access to equitable care," said California Surgeon General Dr. Diana Ramos. “This initiative aligns with our shared commitment to reducing maternal mortality and morbidity, ensuring healthier futures for families across California."

WHY THIS IS IMPORTANT: Medi-Cal-members have a higher rate of maternal mortality than individuals with commercial insurance. Poor maternal health outcomes disproportionately impact Black, Indigenous, and People of Color, particularly those in the Southern Central Valley and Northeastern/Northern Central Valley regions of California.

DHCS will implement the TMaH Model in the five counties characterized by some of the highest pregnancy-related mortality rates in California, where C-sections and rates of prenatal and postpartum depression are higher than the statewide average. There is also a greater need for maternity care providers and health-related social services in these regions compared to others in California.

A STEP FORWARD IN HEALTH EQUITY: For pregnant people, particularly those in rural and underserved areas, this initiative represents a significant opportunity to access improved services that support their birthing plan. The TMaH Model is part of California's broader commitment to addressing racial and ethnic disparities in maternal health and ensuring that all pregnant people, especially people in low-income communities, receive the support they need to safely navigate pregnancy and childbirth. TMaH is a key pillar in DHCS' strategy to improve outcomes for pregnant and postpartum individuals.

"This is an important step forward in our ongoing efforts to address maternal health disparities in California," said Palav Babaria, Chief Quality and Medical Officer and Deputy Director of DHCS' Quality and Population Health Management. "By testing new models of care, California is leading the way in advancing health equity, particularly for communities that have been historically underserved or disadvantaged in accessing timely, effective maternal care."
 
BACKGROUND: The TMaH Model will provide $17 million in funding over the program's course. CMS will award this funding to DHCS in two phases: $8 million during the three-year pre-implementation period (2025-2027) and $9 million during the seven-year implementation period (2028-2035). DHCS will leverage this funding for technical assistance and infrastructure support that will be made available to providers and key implementation partners in the five counties to meet required milestones, including the rollout of a VBP model aimed at rewarding providers for delivering high-quality care.

The TMaH Model will provide valuable insights into the impact of value-based care models on maternal health. It will emphasize improving care coordination, enhancing provider training, and offering holistic support that accounts for social drivers of health, including housing, food security, and transportation.

BIGGER PICTURE: TMaH aligns with and will be complementary to DHCS' Birthing Care Pathway, a comprehensive policy and care model roadmap to cover the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum. The Birthing Care Pathway is being developed to be a strategic roadmap for state entities, managed care plans, counties, providers, social service entities, philanthropy, and other key partners in providing services to pregnant and postpartum Medi-Cal members. The roadmap will include a series of policy recommendations that aim to address the physical, behavioral, and health-related social needs of pregnant and postpartum members by improving access to providers, strengthening clinical care and care coordination across the care continuum, providing whole-person care, and modernizing how Medi-Cal pays for maternity care. Additionally, TMaH aligns with DHCS' Bold Goals 50x2025 initiative, which was launched in 2022 as a focused campaign to improve the quality and equity of care in three focus areas outlined in DHCS' Comprehensive Quality Strategy: children's preventive care, behavioral health integration, and maternity care.

DHCS has already implemented several required TMaH Model elements and other initiatives that will contribute to the success of TMaH, such as adding doula, dyadic care, and community health worker benefits; extending Medi-Cal coverage from 60 days to 12 months postpartum; facilitating enrollment of children and newborns eligible for Medi-Cal through expanding the Children's Presumptive Eligibility Program and establishing the Newborn Gateway; requiring perinatal screenings and assessments to address whole-person needs; implementing health-related social needs Community Supports services (e.g., housing supports, medically tailored meals); and launching a Birth Equity Population of Focus under the Enhanced Care Management benefit that offers high-touch care management to eligible pregnant and postpartum individuals.