The State of California’s (CA) Department of Health Care Services (DHCS), the single state agency for California’s Medicaid program, Medi-Cal, seeks to participate in the Centers for Medicare and Medicaid Services’ new Transforming Maternal Health (TMaH) Model. Participation in TMaH will advance DHCS’ ability to achieve its maternal health policy priorities and continue investing in the future of equitable birthing care in CA. Specific project goals include: 1) improve overall maternal health outcomes; 2) close the significant racial and ethnic disparities in maternal health outcomes and, 3) implement a value-based payment (VBP) model that incentivizes high-quality maternity care for CA’s Medicaid birthing population.
DHCS plans to implement TMaH in the Medi-Cal Managed Care (MCMC) program within a sub-state test region comprised of five counties (Fresno, Kern, Kings, Madera, and Tulare). Approximately 96.4% of Medi-Cal members in the test region are enrolled in MCMC. The five test region counties were identified based on several factors, including high rates of maternal mortality and morbidity relative to the statewide average; average number of Medi-Cal-covered births per year; racial, ethnic and geographic diversity, including racial and ethnic groups experiencing disproportionately high rates of maternal mortality and morbidity; Tribal nation representation; Federally Qualified Health Center and public hospital representation; and DHCS’ rating regions for managed care plan payment. A comparison region, inclusive of Sacramento and San Joaquin counties, is similar to the test region in terms of maternal mortality and morbidity, racial/ethnic diversity, Medi-Cal birthing population size, maternity care and other resource availability, and total population size and density. DHCS expects to have no service overlap between the proposed test and comparison regions.
TMaH implementation in CA will be strengthened by DHCS’ existing maternal health and equity initiatives (Birthing Care Pathway, Comprehensive Quality Strategy, Medi-Cal Transformation, among others), an expansive and integrated approach to maternal health care delivery (midwives, doulas, free-standing birth centers, maternal mental health care, etc.), and a deep bench of community stakeholders, partners and members whose feedback informs DHCS’ policy design efforts.
The total budget for this project is $17 million (Federal Funds). Funds will be used for 1) provider infrastructure payments to support the implementation of care delivery changes, 2) investments in community and stakeholder engagement activities and payment model design, 3) contractors to support project implementation and design, and 4) additional new staff to manage Model implementation.
