The Wisconsin Department of Health Services (DHS) is applying for the Transforming Maternal Health (TMaH) model to expand access to high-quality services in areas of the state with significant maternal and infant health disparities. DHS plans to partner with managed care plans to implement the model in HMO Regions 1, 3, and 6, which include Milwaukee County and rural areas in Northwestern Wisconsin. DHS is requesting $16.5 million, including $6.6 million for personnel, $6.3 million for provider infrastructure payments, $3.3 million for contractual services, and $30,000 for beneficiary honoraria.
DHS plans to leverage the technical assistance and funding provided through the TMaH model to build on existing partnerships and initiatives. DHS oversees Medicaid, the largest single payer of services to birthing people. In Wisconsin, Medicaid covered 35% of births from 2018 through 2022, or an estimated 109,000 of 309,800 births. Because Medicaid is the state’s primary safety-net provider of health care services, it plays an outsized role in facilitating healthy outcomes for the highest risk pregnant and postpartum women. DHS also oversees the Division of Public Health (DPH), which provides services to pregnant, postpartum, and parenting people. These DHS divisions, along with managed care plans, local providers, and partners, will be integral to planning and implementing the TMaH model in Wisconsin.
To improve maternal health, DHS has consistently pursued Medicaid reimbursement for community health workers and doulas, extension of the Medicaid postpartum eligibility period to 12 months, and Medicaid expansion. To date, these proposals have not been approved by the Legislature. The TMaH model gives DHS a platform to show policymakers that we can reduce Medicaid expenditures while addressing disparities through evidence-based practices (such as value-based payment models) that grow the workforce and expand coverage.
The model will help address Wisconsin’s health disparities. In recent years, non-Hispanic Black infants were three times more likely to die before their first birthdays than non-Hispanic white infants. The infant mortality rate for American Indian or Alaska Native infants was 1.5 times the rate for non-Hispanic white infants.i The causes of poor maternal and birth outcomes are varied, reflecting health risks such as poor nutrition, proximity to firearms, substance use disorder, insecure housing, and lack of access to quality physical and behavioral health care. The data continue to show that a comprehensive approach is needed to address disparities, including investments in maternal and infant health programs, expanded access to high-quality health care services, and initiatives to address racial bias in health care to ensure that patients receive appropriate and respectful care tailored to their needs.
Wisconsin plans to leverage the TMaH model to increase access to care, implement a value-based payment model to incentivize high-quality care, improve data analysis, and strengthen community-based interventions through care coordination and workforce investments. The model would support additional covered services in areas such as behavioral health care, diabetes care, hypertension care, and care to address health-related social needs. Early, high-quality prenatal support is essential to healthy pregnancies. Individuals with higher risk factors for poor birth outcomes are more likely to face obstacles in getting adequate and timely care. Potential outcomes of participation in the model include lower rates of severe obstetric complications, pre-term births, and low-risk cesarean deliveries; reduced maternal health disparities; and a stronger maternal health workforce.
i Wisconsin Department of Health Services. (2023). DHS Releases New Reports on Infant Deaths in Wisconsin.
https://www.dhs.wisconsin.gov/news/releases/051823.htm.
