Background

TMaH is a 10-year delivery system and payment reform model designed to implement a whole-person approach to pregnancy, childbirth, and postpartum care to improve birth outcomes and experiences for childbearing families with Medicaid and CHIP coverage. On January 6, 2025, CMS named the 15 jurisdictions that will officially participate in the TMaH Model:

CMS will provide up to $17 million and technical assistance to these states’ Medicaid agencies over 10 years to transform how maternity care is provided, who provides it, and how to pay for care that childbearing families need and want. The ultimate success of the model requires centering leaders of the birth justice movement and others from communities most affected by the crisis throughout the entire process–from planning, to implementation, to evaluation.

States not formally participating should use TMaH’s features and elements as a roadmap to improve maternal and infant health in their state.

How TMaH Aims to Transform Maternity Care

TMaH is an important lever for achieving crucial quality improvements in maternity care. TMaH’s initiatives center on three main pillars: (1) access to care, infrastructure, and workforce capacity, (2) quality improvement and safety, and (3) whole-person care delivery. Each pillar has mandatory and optional evidence-based elements for state transformation plans. These include many policies that birth justice leaders and advocates have long championed, such as:

• Increasing access to midwives, birth centers, doulas, and perinatal community health workers;
• Providing risk assessments, referrals, and follow-ups for perinatal depression, anxiety, substance use disorder, and health-related social needs;
• Leveraging payment and accountability in the service of better maternity care and maternal and infant health outcomes for families;
• Delivering personalized care that is consistent with individual values, preferences, and needs; and
• Investing in data infrastructure to support data collection and sharing to understand and improve care for priority subgroups.

What’s Next for TMaH States?

Participating states are in a three-year pre-implementation period, working with CMS, legislatures, Medicaid health plans, state perinatal quality collaboratives, community-based organizations, and others to strengthen perinatal systems and to engage a broad range of stakeholders, including people from the most affected communities.

Following the pre-implementation phase, states will execute the model over seven years. Key priorities, which are crucial in the model’s ability to improve maternal health, include:

• Payments for better care, experiences, and outcomes: The main system for paying for health care in the U.S. (fee-for-service) rewards providing a lot of expensive care, regardless of whether it is needed or how well it works. The TMaH Model aims to reward accountable care. In year three, state Medicaid agencies will use part of their funding to pay providers for care delivery transformation activities. The following year, providers will be eligible for upside-only performance incentive payments. By year five, state Medicaid agencies will transition to a value-based payment model.
• Partnerships with community-based organizations: For this model to be successful, the design and implementation of each state’s program must be done in close collaboration with the birth justice community. States should utilize the three-year pre-implementation period to foster and/or deepen partnerships between maternity care providers, health systems and hospitals, birth centers, perinatal community health workers, community-based organizations, managed care entities, and Perinatal Quality Collaboratives. Explore the National Partnership’s guide to center the voices of birth justice and community leaders throughout the entire process.
• Sufficient resources and infrastructure to collect complete and accurate data on priority subgroups: Self-reported demographic data is the gold standard that should continue to be used by state Medicaid programs. Without the right data and stratified outcomes, it is impossible to hold providers accountable for improving care for priority subgroups. However, the completeness and accuracy of these reported data vary by state due to a myriad of challenges.

A Roadmap for All States

TMaH is a comprehensive framework that all states can use to guide their maternal and infant health improvement efforts, even if they are not formally participating in CMS’s program.

To assist state Medicaid agencies and maternal health advocates and other stakeholders, the National Partnership for Women & Families developed a playbook that provides implementers with the “why” and the “how” of both mandatory and optional TMaH elements – including concrete checklists, specific resources, and the evidence about their value. This includes model elements such as:

• Covering perinatal community health workers
• Expanding group prenatal care
• Increasing the use of home visits, mobile clinics and telehealth

Most importantly, in order to succeed, efforts must be shaped by the priorities and expertise of the people most impacted. This may include activities such as hosting community listening sessions, forming a community advisory council to co-create policy solutions, and establishing other avenues for both community input and decision maker accountability.

TMaH has the potential to be transformational, but it will require all key stakeholders to get involved – from the design, to implementation, to evaluation. The maternal health crisis demands immediate and comprehensive action now.