The California Department of Health Care Services has been selected as one of just 15 states by the Centers for Medicare & Medicaid Services to implement its Transforming Maternal Health Model, a 10-year Medicaid and Children’s Health Insurance Program delivery and payment model designed to improve maternal health outcomes, reduce costs, and address serious gaps in health care across California.

The Transforming Maternal Health, or TMaH, Model works by reimbursing providers based on patient health outcomes and quality of care, rather than the volume of services provided.

By focusing on improving maternal outcomes, reducing costs and enhancing the quality of care, the model aims to reduce unnecessary cesareans, lower maternal morbidity, and increase access to maternal care providers, such as midwives, doulas and birth centers, for Medi-Cal members.

“It is unacceptable that the color of your skin or your income can dictate the level of care you receive when you’re pregnant. California refuses to accept that status quo, which is why we applied for funding to begin this important initiative that puts quality of care over profits and allows doctors to focus on the patient in front of them. I am eager to see the success of the TMaH Model impact our Medi-Cal members,” said Gov. Gavin Newsom.

“Your chances of surviving pregnancy and childbirth should not be determined by your race, ethnicity, or background. Yet for far too long, Black and Brown women and Medi-Cal members have faced systemic inequities that compromise their health and dignity. In California, we’re prioritizing maternal health and safety, ensuring that every woman and every family receives the compassionate, high-quality care they deserve,” said First Partner Jennifer Siebel Newsom.

Addressing inequities in maternal health care

Medi-Cal-members have a higher rate of maternal mortality than individuals with commercial insurance. Poor maternal health outcomes disproportionately impact Black, Indigenous, and other communities of color, particularly those in the rural regions of Southern Central Valley and Northeastern/Northern Central Valley regions of California.

This initiative will bring improvements to the state’s maternal care system, particularly for pregnant Medi-Cal members and their infants, who traditionally experience disparities in maternal health care access and outcomes.

The TMaH model will focus on areas with the greatest need for intervention and resources. The Department of Health Care Services will implement the TMaH Model in five Central Valley counties (Fresno, Kern, Kings, Madera and Tulare).

The TMaH Model will provide $17 million in funding over the program's course.

The TMaH Model will provide valuable insights into the impact of value-based care models on maternal health. It will emphasize improving care coordination, enhancing provider training, and offering holistic support that accounts for social drivers of health, including housing, food security and transportation.

TMaH aligns with and will be complementary to DHCS’ Birthing Care Pathway, a comprehensive policy and care model roadmap to cover the journey of all pregnant and postpartum Medi-Cal members from conception through 12 months postpartum. The Birthing Care Pathway is being developed to be a strategic roadmap for state entities, managed care plans, counties, providers, social service entities, philanthropy, and other key partners in providing services to pregnant and postpartum Medi-Cal members.