Service delivery and payment model designed to improve maternal health care outcomes for people in Medicaid and CHIP. - New Jersey is committed to improving access to maternal health services while also supporting a whole-person care-delivery approach to pregnancy, childbirth, and postpartum care. New Jersey has already established and maintained building blocks of the TMaH model and believes its participation in the model will support the following statewide priorities: reducing barriers to care, expanding and diversifying maternal health providers, and improving quality of maternal health care. High quality maternal and infant health is a priority for NJ Medicaid. Approximately 30% of annual births are covered by Medicaid (NJ-DOH, CY2022). Birthing individuals who identify as Black and Hispanic are approximately three times more likely to be covered by Medicaid than by other insurance (NJ-DOH, CY2022). Therefore, high quality maternal and infant health care within Medicaid can not only make a substantial impact on outcomes statewide, but can also reduce racial and ethnic health disparities for NJ’s birthing individuals and newborns. In 2019, First Lady Tammy Murphy launched NurtureNJ, a statewide initiative to make the State the safest and most equitable state in the nation to deliver and raise a baby. Alongside investments in the maternal health space made by other state agencies, NJ Medicaid has made significant efforts to increase access to coverage, support whole-person care, and diversify the perinatal workforce: For example, we expanded Medicaid coverage for up to 12 months after the end of pregnancy, mandated use of a comprehensive Perinatal Risk Assessment for all Medicaid pregnancies, and provided Medicaid coverage for community doulas and all licensed midwives. But more is needed to ensure that these recent policy advances have the desired impact on the experience of maternity care by our NJ Medicaid members. The gap between policy and the individual’s experience of care is highlighted by NJ’s recent grade of C+ by March of Dimes Report Card (2023, Preterm birth rate)—even with adoption of every one of their recommended policies to improve and sustain maternal and infant health care. NJ Medicaid’s goal with our application for CMMI’s Transforming Maternal Health Model is to bring sustainable, measurable improvements in maternity care experienced by our members. Given the existing implementation of several core elements of the TMaH care delivery Model, we propose statewide implementation to leverage our current momentum in perinatal workforce development, person/family-centered care, and data-driven quality improvement. We plan to prioritize deep member, provider, and community engagement during pre-implementation to gain insights into a member’s journey through care. These insights will inform our guidance around the use of Provider Infrastructure payments to help effectively drive systems change. We will bring our learnings from our current statewide perinatal episode of care pilot to transition it into a more robust TMaH payment model. Importantly, we plan to do all of our work in close collaboration with our state agency and community partners to ensure we are maximizing the impact of our statewide investments and avoiding duplication of efforts. NJ Medicaid requests $17 million dollars to support implementation of TMaH. These dollars will be used in three ways: One, investments in deep stakeholder engagement to understand the member, provider, and community-based organization experience of care—including compensating members for their expertise from lived experience. They will also be used to develop peer-to-peer technical assistance for providers participating in the TMaH payment model. Two, Provider Infrastructure payments to support providers in impactful engagement with the TMaH Model. Three, Medicaid staffing to increase our capacity to support the qualitative, quantitative, and technical work needed for a successful TMaH Model.
