Federal Actions on Key Maternal Health Policy Priorities: An Overview for Counties
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Blaire Bryant
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Key Takeaways
Across the country, counties are facing a critical maternal health crisis. According to March of Dimes, 4.7 million birthing people live in counties with limited maternity care access. Further, Black and Indigenous birthing people are experiencing three- and five-times higher mortality rates than non-Hispanic white people, demonstrating the growing disparities in outcomes across populations.
According to the Center for Disease and Control’s (CDC) Pregnancy Mortality Surveillance System (PMSS) data released on May 17, 2024, the pregnancy-related mortality ratio in the U.S. increased from 17.6 deaths per 100,000 live births in 2019 to 24.9 deaths per 100,000 live births in 2020. The highest pregnancy-related mortality ratios were among American Indian or Alaska Native people (63.4 per 100,000 live births in 2020) and Black people (55.9 per 100,000 live births in 2020).
Counties play a key role in managing the various systems that influence maternal health outcomes and are deeply invested in promoting equity and positive birth outcomes. As owners and administrators of the local health and human services social net, counties play a critical role in improving the health of pregnant and postpartum people alongside federal and state partners. Counties are investing in community-based interventions, such as doula services, to combat the nation's rising maternal mortality rates and address the social determinants of health that impact perinatal outcomes.
Congressional action
NACo continues to advocate for county policy priorities that affect change across systems impacting maternal health and promote the family ecosystem for better outcomes for birthing people and infants. These priorities include:
- Authorizing and fund county-led pilots to address maternal and infant health from a Social Determinants of Health approach
- Streamlining eligibility and application requirements across key safety net programs to enable integrated benefits delivery
- Investing in technology upgrades and authorize data sharing to enable cross-enrollment and communication across local agencies
- Authorizing and fund grant programs aimed at strengthening the county health and human services workforce, as well as prioritizing enhancement of workforce diversity
- Providing technical assistance and facilitate exchange across levels of government to help scale innovative local solutions
Below is an outline of congressional action:
Legislation | Action/Description |
Amends title XIX of the Social Security Act to provide coverage under the Medicaid program for services provided by doulas and midwives, and for other purposes.
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Preventing Maternal Deaths Reauthorization Act of 2023 (H.R.3838) | Reauthorizes funding through Fiscal Year 2028 for state based maternal review committees to review pregnancy-related deaths. These committees identify causes and make recommendations to improve and reduce disparities in maternal health outcomes. The bill also requires the Centers for Disease Control and Prevention to share best practices with key stakeholders, like hospitals, annually relating to preventing maternal morbidity and mortality.
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Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Reauthorization Act of 2023 (H.R.3226)
| Reauthorizes through Fiscal Year 2028 and supports research and education for preventing premature births. |
Maternal and Child Health Stillbirth Prevention Act of 2023 (S.2231) | On October 4, 2023, the Senate passed S.2231, the Maternal and Child Health Stillbirth Prevention Act of 2023 which amends Title V, the Maternal and Child Health Services Block Grant of the Social Security Act. This legislation aims to clarify that the stillbirth prevention activities and research are an allowable use of the grant funds and will therefore help to save the lives of mothers and babies. |
Directs multi-agency efforts to address maternal mortality, morbidity, and disparities, with a particular focus on addressing the outcomes for racial and ethnic minority groups, veterans, and other vulnerable populations. On March 25, 2023, Rep. Underwood appeared before the House Veterans Affairs Committee to testify in support of the Momnibus legislation.
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Administrative Action
Since the release of the White House Blueprint for Addressing the Maternal Health Crisis in June 2022, agencies within the Department of Health and Human Services and across the Administration have been working to advance its aims. A White House Convening in December 2023, featuring the Domestic Policy Advisor to the Vice President and the Domestic Policy Council Director, brought together private sector leaders to discuss investing in women's health and bolstering public-private partnerships. This discussion emphasized ongoing efforts to enhance maternal health services and served as a catalyst for further actions this year, which are outlined below.
U.S. Department of Health and Human Services (HHS)
Action | Description |
Launch of the Maternal Mental Health Task Force | In September 2023, a new HHS Task Force on Maternal Mental Health was announced. Co-chaired by the HHS Assistant Secretary for Health and Assistant Secretary for Mental Health and Substance Use, the task force will evaluate and make recommendations on best practices, data, health equity, communications, community engagement, and more.
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Launch of the Talking Postpartum Depression Campaign
| Additionally, the Office of Women’s Health (OWH) launched a national campaign in September 2023 called Talking Postpartum Depression. This campaign, featuring personal stories of those who have experienced and sought help for postpartum depression (PPD), is meant to educate women, encourage them to seek help and increase visibility of PPD and reliable resources.
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HHS Launches Postpartum Maternal Health Collaborative
| On February 14, 2024 HHS announced a new six state collaborative initiative to address postpartum mortality. This new collaborative seeks to bring together state experts, local providers, community partners, and federal experts to develop a better understanding of the challenges being experienced among the postpartum population and support new solutions that will improve postpartum mortality. The states participating in the initiative include Iowa, Maryland, Massachusetts, Michigan, Minnesota, and New Mexico.
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45 States have adopted Postpartum Coverage Option Under Medicaid and CHIP | On March 8th, 2024, HHS announced Utah’s extension of comprehensive coverage for postpartum individuals for a full 12 months through Medicaid and the Children’s Health Insurance Program (CHIP), expanding access to an additional 4,000 people. This brings the total number to extend postpartum coverage to 45 states across the U.S, a critical step towards a goal outlined in the blueprint.
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Center for Medicaid and Medicare Services (CMS)
Action | Description |
New Postpartum Care Guidance | CMS released a guidance document in August 2023, entitled “Increasing Access, Quality, and Equity in Postpartum Care in Medicaid and CHIP,” meant to serve as a resource for state Medicaid and CHIP agencies to help them maximize their authorities for increasing postpartum care access, quality, and equity.
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“Birthing Friendly” Designation Launch | In November 2023, CMS launched the “Birthing Friendly” designation icon, the first federal quality designation focusing on maternal health (Outlined in Goal 2.1 of the White House blueprint). This tool found on CMS’s Care Compare online tool will help patients identify hospitals and health systems that are participating in a statewide or national perinatal quality improvement collaborative program and are implementing evidence-based practices to improve maternal health. See the Interactive Map https://data.cms.gov/provider-data/birthing-friendly-hospitals-and-health-systems
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The Launch of the Transforming Maternal Health Model | In December 2023, CMS announced the Transforming Maternal Health (TMaH) Model. This payment and care-delivery model is designed to support the improvement of maternal healthcare for those enrolled in CHIP and Medicaid. Each state Medicaid agency will be eligible for up to $17 million across the 10-year period. The TMaH model’s main pillars are:
CMS is currently soliciting applications for the TMaH Model. This is a voluntary, 10-year service delivery and payment model designed to improve maternal health care outcomes for people enrolled in Medicaid and the Children's Health Insurance Program (CHIP). See the full Notice of Funding Opportunity here. |
Health Resources and Service Administration (HRSA)
Action | Description |
Expanded Funding for HRSA Programs | HRSA announced in September 2023 roughly $90 million in awards to support activities outlined in the White House Blueprint. This will support innovative solutions, increasing access to care in rural and underserved communities, grow the maternal health workforce, expand screening and treatment for maternal mental health and substance use disorders and uplift community-based initiatives. |
New report on maternal health at the local level
To better understand the challenges and opportunities for county government in supporting pregnant and postpartum people, the National Association of Counties Research Foundation (NACoRF) surveyed county officials on their role and authority in maternal health, gaps and barriers in maternal care systems and county-level solutions and priorities. This report highlights survey findings alongside focus group and interview responses to share the critical role of counties in serving pregnant and birthing residents. County leaders can use this information to guide development of comprehensive, accessible and equitable local maternal health care systems.
Resources for counties
In addition to participating in the initiatives mentioned above, counties can leverage the following resources to receive direct assistance in addressing maternal health in their communities:
- Funding: Seek federal grant funding to support local maternal health initiatives
- Services: Promote the National Maternal Mental Health Hotline to constituents
- Data: Use the Maternal and Infant Health Mapping Tool to compare data and information on maternal and infant health across different counties
Counties commend Congress and the administration for their efforts to collaborate with local governments in addressing maternal health. NACo will continue to communicate crucial updates and resources regarding maternal health at the federal level, while also highlighting local best practices and advocating for policy changes relevant to counties.
Want to see what else NACo is doing to advance maternal health priorities?
Resource
The County Maternal Health Landscape: Inequities, Barriers and Recommendations
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