DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
CMCS Informational Bulletin 
 
 
 
DATE:  July 17, 2014 
 
FROM:  Cindy Mann 
      Director 
      Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  CMCS Maternal and Infant Health Initiative 
 
 
This informational bulletin describes opportunities for states to collaborate with CMCS on a new 
national initiative to improve maternal and infant health outcomes in Medicaid and CHIP.  Based 
on consultation with stakeholders, over the next several years, CMCS will focus improvement 
efforts in two areas: 1) increasing the rate and content of postpartum visits; and 2) increasing the 
rate of pregnancies that are intended.   
 
Background 
 
Recognizing the urgency presented by our nations poor birth outcomes, CMCS is experiencing a 
unique time in this nations history in which the federal and state governments, maternal and 
infant health advocacy groups and provider groups are working in tandem to improve perinatal 
outcomes and reduce disparities. As the payer for at least half of all births in the U.S.,1 Medicaid 
and CHIP have an important role to play.  Adverse birth outcomes such as preterm birth and low 
birth weight, with their associated economic and social costs, are far reaching; furthermore, their 
impacts can be long-lasting, particularly among the most vulnerable populations.  Medicaid is an 
important source of health insurance coverage for vulnerable individuals and families; and while 
considerable progress has been made in improving birth outcomes in the last decade among 
public and private payers, the rate of births reported as preterm or low birth weight remains 
higher in Medicaid than private insurance (10.4% vs. 9.1%).2 
 
In 2012, the Department of Health and Human Services launched Strong Start for Mothers and 
Newborns, which is funding 27 grantees over the next four years to test the effectiveness of three 
models of enhanced prenatal care  for reducing preterm births in Medicaid and/or CHIP.3   In an 
effort to identify strategies that could be adopted in the short term, an Expert Panel on Improving 
                                                 
1 Markus A. R., E. Andres, K.D. West, N. Garro, and C. Pellegrini. Medicaid Covered Births, 2008 through 2010, 
in the Context of the Implementation of Health Reform. Womens Health Issues, vol. 23, no. 5, 2013, pp. e273
e280. 
2 Barradas D.T., et. al. Hospital Utilization and Costs among Preterm Infants by Payer: Nationwide Inpatient 
Sample, 2009. Unpublished  manuscript 2014. 
3 The models of enhanced prenatal care are centering/group care, birthing centers, and medical homes. For 
additional information see Strong Start . CMS will also evaluate HRSAs Maternal, Infant, and Early Childhood 
Home Visiting program (MIECHV) as a fourth model of enhanced prenatal care.  Page 2  CMCS Informational Bulletin 
Maternal and Infant Health Outcomes in Medicaid and CHIP (the Expert Panel) was convened 
by a CMCS contractor to explore program, policy and reimbursement opportunities that could be 
adopted to provide better care, improve birth outcomes and reduce the cost of care for mothers 
and infants (additional information about our Expert Panel is available on Medicaid.gov). This 
stakeholder convening served to inform opportunities for Medicaid to address birth outcomes 
and complemented existing Departmental investments in improving maternal and infant health.   
 
Initiative Goals 
 
After considering the advice of the Expert Panel and partnership opportunities, CMCS has 
identified two distinct yet interrelated goals for its Maternal and Infant Health Initiative.  The 
initiative leverages existing partnerships and activities to: 
 
  Increase by 10 percentage points the rate of postpartum visits among pregnant women in 
Medicaid and CHIP in at least twenty states over a 3-year period; and 
 
  Increase by 15 percentage points the use of effective methods of contraception in 
Medicaid and CHIP in at least twenty states over a 3-year period. 
 
These goals consider the critical benefits that can be realized when women receive appropriate 
and timely postpartum care.  Regular postpartum visits have positive implications for the 
womans health, infant care and health, and also subsequent pregnancies.   In addition, 
reproductive planning which includes access to contraception, either during the immediate 
postpartum period or during any other time in the reproductive continuum, allows for appropriate 
birth spacing and improved access to services that can, in turn, improve perinatal outcomes.   
 
Action Steps 
 
One of the key themes that emerged from the Expert Panel is that current public and private 
reimbursement mechanisms do not align well with achieving good perinatal outcomes.  Through 
the Maternal and Infant Health Initiative, CMCS will provide technical assistance to support 
Medicaid agencies in implementing reimbursement and related policy changes to achieve these 
goals. CMCS will also provide technical assistance to states that seek to improve health coverage 
for women before and after pregnancy utilizing existing coverage options, expansion 
opportunities and new delivery models.  Through this initiative, CMCS will promote payment, 
program and coverage policies that enhance provider service delivery for use of effective 
contraception and timely postpartum care and enhance the accessibility of these services to 
women. 
 
Assessing Progress 
 
To determine a baseline and to assess progress toward the goals, states will be invited to 
voluntarily report on 2 quality measures: 
 
1)  The measure for Postpartum Care from the Medicaid Adult Core Set; and  
2)  A developmental measure on Contraception Service Utilization.  Page 3  CMCS Informational Bulletin 
 
The specifications for reporting the Postpartum Care measure are contained in the Technical 
Specifications and Resource Manual for the Adult Core Set.4  The measure assesses the rate of 
postpartum visits occurring on or between 21 and 56 days after delivery.  The developmental 
Contraception Service measure5 is claims based and consists of two rates to assess the proportion 
of women who received contraceptive services in the past 12 months that adopt or continue use 
of: 
 
a)  The most effective (i.e., male or female sterilization, implants, intrauterine devices or 
systems (IUD/IUS)) or moderately effective (i.e., injectables, oral pills, patch, ring, or 
diaphragm) FDA-approved methods of contraception;  
b)  An FDA-approved, long-acting reversible method of contraception (i.e., implants, 
intrauterine devices or systems (IUD/IUS)).   
 
To report on these measures, states will use the CARTS6 web-based data submission tool that is 
used for the Medicaid Adult Core Set measures.  Baseline data for the initiative will be 
reportable with 2013 submissions, due by January 31, 2015.  To facilitate reporting of these 
measures, CMCS will make available an incentive payment to states that choose to participate in 
this initiative.  Details about the process for qualifying for the reporting incentive payment will 
be announced when the specifications for the Contraceptive measure are released.   
 
Next Steps 
 
Over the next several months, CMCS will host a series of webinars to provide more information 
about the Initiative and review the performance measures that will be used to track our collective 
progress toward improving outcomes.   
 
CMCS welcomes the opportunity to work more closely with states in advancing improvements 
in perinatal outcomes.  For additional information on the Maternal and Infant Health Initiative, 
please contact Lekisha Daniel-Robinson, Coordinator, Maternal and Infant Health Initiative at 
Lekisha.Daniel-Robinson@cms.hhs.gov. 
 
We hope this information will be helpful.  Thank you for your commitment to improving 
maternal and infant health through these critical programs. 
 
                                                 
4 http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Adult-Health-Care-
Quality-Measures.html 
5 CMCS, in collaboration with Centers for Disease Control and Prevention (CDC) and the Office of Population 
Affairs (OPA) will release detailed specifications and resources for the developmental contraception measure by 
mid fall. 
6 Guidelines for submitting to CARTS can be found at: : http://www.medicaid.gov/Medicaid-CHIP-Program-
Information/By-Topics/Quality-of-Care/Adult-Health-Care-Quality-Measures.html