2025 年 1 月 6 日​​ 

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.​​ 

这项举措将改善该州的孕产妇保健系统，特别是对于怀孕的 Medi-Cal 会员及其婴儿而言，他们历来在孕产妇保健服务获取和结果方面面临不平等。TMaH模式将重点关注最需要干预和资源的领域。DHCS将在中央谷地的五个县实施 TMaH 模式： Fresno 、 Kern 、 Kings 、 Madera和Tulare 。​​ 

“通过重点关注这些高需求县，我们正在采取战略性措施，以改善California各地孕妇的健康和福祉，尤其是在孕产妇健康差距最大的地区，” DHCS主任米歇尔·巴斯 (Michelle Baass)说。 “该模式将使我们能够测试创新的孕产妇保健方法，确保每一位怀孕的 Medi-Cal 会员，无论其背景或情况如何，都能获得她们所需的护理，从而拥有健康的孕期和分娩。参与TMaH将提升DHCS实现其孕产妇健康优先事项的能力，并继续投资于公平分娩护理的未来。​​ 

“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.”​​ 

重要性： Medi-Cal 会员的孕产妇死亡率高于拥有商业保险的个人。孕产妇健康状况不佳对黑人、原住民和有色人种的影响尤为严重，特别是加利福尼亚州南部中央谷地和东北部/北部中央谷地地区的居民。​​ 

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.”​​ 

背景： TMaH 模型将在Program实施过程中提供 1700 万美元的资金。 CMS 将分两个阶段向 DHCS 拨付这笔资金：在三年的实施前准备期（2025-2027 年）拨付 800 万美元，在七年的实施期（2028-2035 年）拨付 900 万美元。DHCS 将利用这笔资金为五个县的医疗服务提供者和主要实施伙伴提供技术援助和基础设施支持，以达到既定目标，包括推出旨在奖励提供高质量护理的医疗服务提供者的 VBP 模式。​​ 

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.​​ 

从更宏观的角度来看： TMaH 与 DHCS 的生育护理路径相一致，并将与之互补。该路径是一项全面的政策和护理模式路线图，涵盖所有 Medi-Cal 怀孕和产后成员从受孕到产后 12 个月的整个过程。生育护理路径正在制定中，旨在为州政府机构、管理式医疗计划、县、医疗服务提供者、社会服务机构、慈善机构和其他关键合作伙伴提供战略路线图，以便为怀孕和产后 Medi-Cal 会员提供服务。该路线图将包含一系列政策建议，旨在通过改善获得医疗服务的机会、加强整个护理过程中的临床护理和护理协调、提供全人护理以及使 Medi-Cal 支付孕产妇护理的方式现代化，来解决怀孕和产后成员的生理、行为和健康相关的社会需求。此外，TMaH 与 DHCS 的“ 2025 年 50 周年宏伟目标”计划相一致，该计划于 2022 年启动，旨在通过一项重点活动来提高DHCS 综合质量战略中概述的三个重点领域的护理质量和公平性：儿童预防保健、行为健康整合和孕产妇保健。​​ 

DHCS已实施了 TMaH 模式的几项必要要素和其他举措，这些举措将有助于 TMaH 的成功，例如增加导乐、双人护理和社区卫生工作者福利；将Medi-Cal覆盖范围从产后 60 天延长至 12 个月；通过扩大儿童推定资格Program和建立新生儿门户网站，促进符合Medi-Cal资格的儿童和新生儿的注册；要求进行围产期筛查和评估，以满足全人需求；实施与健康相关的社会需求社区支持服务（例如，住房支持、定制医疗膳食）；以及在强化护理管理福利下启动“生育公平重点人群”计划，为符合条件的孕妇和产后人员提供高触感护理管理。​​ 

###​​ 

Contact:
Office of Communications
(916) 440-7660
www.dhcs.ca.gov​​