In January 2025, the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) awarded the Alabama Medicaid Agency funding to enhance maternal health and birth outcomes for pregnant and postpartum women, as well as their infants. Alabama was one of 15 states to receive the grant as part of the new Transforming Maternal Health (TMaH) Model.
The TMaH Model is a 10-year initiative aimed at improving care delivery for Medicaid and Children’s Health Insurance Program (CHIP) recipients. Alabama's participation in TMaH can increase access to essential maternal health services and support hospitals and health systems in achieving the CMS “Birthing-Friendly” designation— the first federal quality standard focused on maternal health. The initiative also prioritizes screening for social determinants of health, such as food insecurity, housing instability, and substance use disorders, connecting mothers to community-based resources for additional support. The goal of this initiative is to ensure that mothers and their newborns receive the care and resources they need to thrive, with a focus on safety, empowerment, and long-term health.
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Improve maternal and infant health outcomes - by increasing access to diverse maternal care providers (including midwives and doulas)
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Enhance care quality and safety
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Promote whole-person care that addresses mental health and health-related social needs
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Transition from fee-for-service to value-based payment models that incentivize quality and cost-effective care
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Partner with clinical, community, and public health organizations to build data infrastructure, implement patient safety protocols, expand access to supportive services, and ultimately reduce preventable maternal morbidity and mortality while controlling Medicaid expenditures over the 10-year initiative.
TMaH Model Development Timeline
December 15, 2023: CMS announced TMaH Model
June 26, 2024: Notice of funding opportunity (NOFO) released
September 20, 2024: Applications for TMaH grant due
January 1, 2025: TMaH Model launched
TMaH Phases
The Pre-Implementation Period is a three-year pre-implementation period focused on providing funding and technical assistance to help State Medicaid Agencies (SMAs) build capacity, prepare for value-based payment implementation, and meet key readiness milestones within defined geographic areas.
The Implementation Period is a seven-year implementation period focused on testing a payment model with cost and quality incentives, meeting state-specific milestones, expanding access to services like doulas and midwives, and strengthening patient safety through continued partnerships.
Participation
The TMaH Model participation requires State Medicaid Agencies (SMAs) to recruit partner providers (like obstetricians, midwives, doulas, and clinical staff), partner care delivery locations (such as hospitals, birth centers, FQHCs, and other care sites), and partner organizations (including managed care plans, public health departments, and community-based organizations). While SMAs must recruit these partners, actual provider participation in the model is voluntary.
Alabama TMaH Stakeholders
Alabama Medicaid has begun preliminary discussions with stakeholders, including but not limited to:
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Alabama Coordinated Health Network (ACHN)
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Other Alabama State Agencies
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Maternal Health Providers
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Professional Advocacy Groups in Alabama
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Other Health Insurers
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Hospitals and Medical Universities
Pillars of TMaH
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Pillar 1: Focus on improving maternal health by increasing access to diverse providers like midwives and birth centers, covering doulas, enhancing data infrastructure, developing a payment model, and establishing regional partnerships especially in rural areas.
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Pillar 2: Focus on enhancing maternal care quality and safety by implementing patient safety protocols, encouraging “birthing-friendly” facility designations, and promoting shared decision-making between patients and providers.
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Pillar 3: Emphasize whole-person care by covering risk assessment, referrals, and follow-up for perinatal mental health, substance use, and health-related social needs; supporting home monitoring of diabetes and hypertension; and expanding home visits, mobile clinics, and telehealth services.
Where are we now?
Currently, with the TMaH grant, progress includes ongoing technical assistance calls with CMS, completing an initial needs assessment and tailored workplan, establishing a Governance Committee and Leadership Council, engaging stakeholders, building new and existing partnerships, and actively recruiting providers.
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The cross-agency governance committee meets quarterly, with workgroups meeting more frequently as needed to support ongoing collaboration and progress. Each workgroup elects a lead to keep members focused and report updates during quarterly meetings, while Medicaid staff provide guidance and support.
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The leadership council includes two representatives from each of these professions—General OB/GYN, Maternal Fetal Medicine, Hospital Systems, Family Medicine Obstetrics, Doulas, and Certified Nurse Midwifery. The council provides input on value-based payment (VBP) model development and meets twice a year.
Where are we going?
Next steps include developing a State Plan Amendment to cover doula services, completing payment analyses for midwives, doulas, and birth centers, assessing midwifery workforce capacity, planning Model Year 4 and 5 payment implementations, and implementing a Value-Based Payment model by Model Year 5.
Provider Infrastructure Payments
For more information on TMaH Model payment approaches for providers visit https://www.cms.gov/priorities/innovation/innovation-models/transforming-maternal-health-tmah-model to access the Notice of Funding Opportunity.
Value-Based Payment Model
CMS will design a payment model aligned with federal Medicaid and CHIP rules, allowing variations based on state laws and local factors. CMS will engage SMAs and stakeholders in structured discussions to shape the Model Year 5 VBP approach with opportunities for feedback. All SMAs participating in the TMaH Model must agree to implement this payment model per NOFO guidelines.
Questions