This blog post is part of an NHeLP series about current initiatives to improve maternity care in California. The first blog post is on the California Department of Health Care Services Birthing Care Pathway. This, the second blog post, is on California’s Transforming Maternal Health Model. The third and final blog post is on the California Rural Health Transformation Program.
In January 2025, the Center for Medicare & Medicaid Services (CMS) selected 15 states to participate in the Transforming Maternal Health (TMaH) Model). This 10-year project, which will run from 2025 to 2034, aims to provide ongoing support to the selected state Medicaid agencies in developing and implementing a whole-person approach to maternal health care by addressing the physical, mental, and social health needs of pregnant and postpregnancy people and newborns through evidence-based strategies. California was one of the states chosen to participate in the TMaH Model, and was awarded $17 million in federal funding for implementation.
DHCS will target California’s TMaH Model in five counties in the Central Valley that experience some of the highest maternal health disparities in the state: Fresno, Kern, Kings, Madera, and Tulare. These five counties rank among the lowest in overall health outcomes of the 58 counties in California. Fresno, Kern, and Tulare Counties have among the highest rates of maternal mortality in the state. At the same time, doula support has been shown to have positive impacts on maternal and infant health outcomes in the region.
Central to the TMaH model is funding to improve access to maternity care providers such as midwives, doulas, and community health workers; address quality concerns and improve the overall safety and experience of childbirth through implementation of “patient safety bundles;” and customize maternity care to meet the specific and whole-person care needs of each pregnant and postpregnancy Medi-Cal enrollee in the targeted counties.
Also critical to the TMaH model is the implementation of evidence-based strategies within a value-based payment framework. This means that health providers will be reimbursed based on quality of care and patient health outcomes, rather than merely the volume of care provided. The value-based payment model is being developed by CMS and will be identical across all 15 TMaH states. Implementation of the value-based payment model will begin in California’s TMaH Model in 2027, and DHCS will begin working with Medi-Cal managed care plans to transition to the value-based payment model starting in 2029.
Importantly, the TMaH Model is complementary with the DHCS Birthing Care Pathway, which has been ongoing since the release of the Birthing Care Pathway Report in 2025. Moreover, since the Birthing Care Pathway aims at improving maternal health care and outcomes across all 58 counties in California, policy alignment between these two efforts means that best practices and lessons learned from the Central Valley counties in the TMaH Model can be transferred to other regions in the state.
