The Louisiana Department of Health (LDH) Bureau of Health Services Financing (BHSF), which serves as the State Medicaid Agency for Louisiana, requests $17,000,000 in order to implement the Transforming Maternal Health (TMaH) Model in a test region (“LA Maternal Care Transformation Zone”) that is comprised of Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll, East Baton Rouge, East Feliciana, Iberville, Pointe Coupee, West Baton Rouge, and West Feliciana parishes (counties) over a ten-year grant period. The comparable region will include Orleans, St. Bernard, Plaquemines, Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine, and Webster Parishes (counties). These test and comparison regions are similarly situated with regards to birth volume, racial and economic characteristics and availability of services. LDH requests $8 million to accomplish activities during the Pre-Implementation Period (model years 1-3), and $9 million during the Implementation Period (model years 4-10). Given that approximately 60% of all births in Louisiana are covered through Medicaid, a complete transformation of Louisiana’s fragmented system of care is necessary to improve maternal health care and birth outcomes while reducing health disparities for all.
The LDH will build on existing efforts over the grant period in order to implement the TMaH model in the LA Maternal Care Transformation Zone with fidelity in order to significantly reduce maternal and infant mortality and increase access to coordinated, high quality perinatal care. Specifically, the LDH will leverage TMaH funding to: 1) Improve its data infrastructure to best meet the needs of stakeholders and strategically address gaps in maternal health care, 2) Increase home monitoring of diabetes and hypertension; and 3) Increase risk-assessment, screening, referrals, and follow up for perinatal depression, anxiety, substance use disorder, and health related social needs (HRSNs). In partnership with CMS, LDH will measure the effectiveness of the TMaH model on improving maternal health outcomes in the LA Maternal Care Transformation Zone in comparison with a similarly situated Louisiana region. Both the LA Maternal Care Transformation Zone and comparison region have about 11,000 births annually. Just under 50% of births in each region are to Black women, while about 40% are to White women. About 10% of births in each region are to people who identify as neither Black nor White. Both the test and comparison regions contain several parishes that are identified by the March of Dimes in a 2021 report as maternity care deserts or areas of low access. (test region: Caldwell, Franklin, Jackson, Richland, Tensas, Union, West Carroll parishes; comparison region: Desoto, Sabine, Bienville, Plaquemines and St. Bernard parishes). Both the test and comparison region have significant racial disparities in perinatal health outcomes and both have outcomes significantly worse than the national average.