States are implementing strategies to improve perinatal outcomes as the U.S. faces high rates of maternal mortality, severe maternal morbidity, and perinatal mental health conditions. The postpartum period is of critical importance as many cases of life-threatening complications can arise after hospital discharge and more than half of pregnancy-related deaths occur between one week and one year postpartum.
Many states are advancing strategies to support high-quality care coordination for Medicaid beneficiaries during the postpartum period to address complex physical health, behavioral health, and social needs. For certain conditions, care management has been found to improve outcomes. The American College of Obstetricians and Gynecologists (ACOG) recommends that providers counsel women with chronic medical conditions, such as hypertension, obesity, diabetes, mood disorders, and substance use disorders, on the importance of timely follow-up for ongoing coordination of care. The postpartum period is also an opportunity to facilitate a transition to primary care and other supports, including services for lactation, infant care, and improving child care access, food and nutrition security, housing stability, interpersonal safety, and transportation access.
Nearly all states have extended Medicaid postpartum coverage from 60 days to 12 months, an option made available by the American Rescue Plan Act of 2021 and permanent under the Consolidated Appropriations Act of 2023. Extending this coverage provides continuity during the postpartum period to address pregnancy-related health concerns and facilitate the transition to ongoing and preventive care. To maximize the impact of extended Medicaid postpartum coverage, some states are conducting outreach and awareness campaigns for providers and beneficiaries:
- Washington created radio ads, social media content, a flyer, and a poster to increase public awareness of extended postpartum coverage (After-Pregnancy Coverage), as well as a bulletin for providers.
- North Carolina also created flyers, bulletins, posters, and fact sheets for beneficiaries and providers and highlighted the state’s postpartum coverage extension on a podcast.
For more on state considerations for extended postpartum coverage, see NASHP’s resource on Optimizing Postpartum Coverage Extension.
This section of the Operationalizing State Medicaid Policy Levers to Strengthen Perinatal Health Systems toolkit is designed to assist state officials in improving maternal health outcomes and the health systems that support care delivery and coordination during the postpartum period. The resource outlines key policy considerations for supporting postpartum care coordination under Medicaid and identifies opportunities for Medicaid and public health, such as Title V Maternal and Child Health (Title V MCH) Services Block Grant programs, to partner to strengthen care coordination during the postpartum period.
Laying the Groundwork to Increase Access to Postpartum Care Coordination
Implement strategies to increase attendance at the initial postpartum visit(s) and support early identification of postpartum needs
A comprehensive postpartum visit(s) is important for ensuring continued recovery and wellness, monitoring for complications, and supporting a transition to primary care or other care needs. Although this visit is important, over one-third of Medicaid beneficiaries do not attend a postpartum visit. Obstetric care, including postpartum care, can be provided by a variety of provider types, including midwives and physicians. Community-based providers, such as doulas, home visitors, and community health workers, may play a role in facilitating postpartum visit attendance.
ACOG recommends that postpartum care be individualized and include contact with a maternal care provider within the first three weeks postpartum, followed by ongoing care as needed and a comprehensive postpartum visit no later than 12 weeks after birth. This care should be individualized and include assessment of a range of health needs, including mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance.
State Medicaid programs are implementing strategies to increase postpartum visit attendance, including offering payment incentives for providers and initiatives to address barriers to accessing postpartum care:
- North Carolina’s Pregnancy Management Program offers participating providers a $150 incentive per Medicaid beneficiary for every postpartum visit.
- At least 12 states and Washington, DC, provide Medicaid reimbursement for doula services during pregnancy and postpartum, with New Jersey, Virginia, and Washington, DC, offering doulas a payment incentive if they perform at least one postpartum visit and the Medicaid beneficiary is seen by an obstetric provider for a postpartum visit.
- New York’s Medicaid Perinatal Care Standards allow for the first postpartum visit to be in-person or via telehealth. These standards set forth policies that apply to all Medicaid perinatal care providers and include a requirement that care must be coordinated by the maternal care provider.
Building Capacity to Implement Postpartum Care Coordination
Develop a perinatal care coordination model that includes supporting extended postpartum care
States are strengthening their systems of care to deliver high-quality and comprehensive perinatal care that includes coordination between clinical and non-clinical providers. State Medicaid agencies are using a variety of mechanisms to build capacity to implement perinatal care coordination services:
- New York’s Medicaid Perinatal Standards require health plans to coordinate care between providers, health plan case managers, or sites of care.
- Wisconsin’s Prenatal Care Coordination (PNCC) is a Wisconsin Medicaid and BadgerCare Plus benefit that provides medical, social, and educational support and services during pregnancy and up to 60 days postpartum. Care coordinators provide a range of services, including finding health care providers and setting up appointments for members; sharing information about food, housing, and transportation services; and providing information on postpartum and infant health. Public and private agencies/organizations must meet certain requirements to enroll as PNCC providers.
- California’s Enhanced Care Management benefit is available to eligible Medicaid managed care members with complex health and social needs, including pregnant and postpartum members. Eligible members receive comprehensive care management to coordinate clinical and non-clinical care and services.
- Louisiana Medicaid allows managed care organizations to offer an “in lieu of” services (ILOS) program for “hospital-based care coordination for pregnant and postpartum individuals with substance use disorder (SUD) and their newborns.” This ILOS provides coverage of a comprehensive pregnancy medical home model of care to pregnant enrollees with SUD up to 12 months postpartum. This model includes care coordination, health promotion, individual and family support, and linkages to community/support services, behavioral, and physical health services. Services under this ILOS are covered without the requirement of prior authorization or referral. Some postpartum care coordination services provided under this ILOS program include identifying/connecting the patient with peer support and providing referrals for medical, developmental, and social support.
States also implement care coordination programs through public health agencies. In some states, maternal health care coordinators are funded by Title V Maternal and Child Services (MCH) Block Grants, including New York’s Perinatal and Infant Community Health Collaboratives Initiative in which community health workers engage “high-risk pregnant, postpartum, and interconception individuals and their families” and provide connection to care and services.
- Pennsylvania’s Title V MCH program supports the 4th Trimester Program, an initiative of the IMPLICIT Network, to address maternal morbidity and mortality in the postpartum period. Participating sites must establish a 4th Trimester Team that, among other things, connects patients with psychosocial, biomedical, and other wrap-around services.
- The Virginia Department of Health works with local health departments to deliver BabyCare, a visitation program provided by registered nurses. Women who are Medicaid-eligible and pregnant or have an infant up to two years of age are eligible to receive services under the BabyCare program. Case management by a registered nurse, health and social needs screenings, and referrals are key components of the program.
Assess barriers to care and strengthen the perinatal health care system to address health care and social services needs
Care coordination can address both health and social needs, including needs related to housing, transportation, and nutrition. Care coordination can be provided by different types of coordinators, including health educators, patient navigators, care managers, community health workers, public health nurses, and recovery specialists. To create pathways to social supports, states can consider developing systems for data sharing, cross-agency partnerships, and implementing screening tools for health conditions specific to perinatal care and other needs such as child care access, food and nutrition security, housing stability, interpersonal safety, and transportation access.
- The Louisiana Provider-to-Provider Consultation Line (PPCL) is a no-cost telephone consultation and education program to help pediatric and perinatal health care providers address their patients’ behavioral and mental health needs. The consultation system supports clinicians in identifying perinatal risks and mental health symptoms, implementing first-line management of mental health and substance use disorders, and making referrals to additional community resources. One of the tools developed by PPCL is Louisiana’s Screening Passport. This tool allows providers to easily share results from a variety of screenings, including postnatal depression, substance use disorder, social needs, and safe home environment, with other health care providers by empowering patients to share their screening results during health care appointments.
- Arkansas established Maternal Life360 HOMEs under a Medicaid Section 1115 demonstration waiver amendment to provide social supports to women with high-risk pregnancies and up to two years postpartum. After a clinician determines a patient is high-risk, home visitors screen for “health-related social needs” and connect patients to community supports and health services. This initiative includes partnerships with state and local entities, including the state Supplemental Nutrition Assistance Program agency and local housing authority, as well as data sharing between the state or partner entities assisting in the administration of the demonstration and social services organizations.
Access NASHP’s brief to learn more about additional ways states are addressing health needs for pregnant and postpartum Medicaid beneficiaries.
Measure, Evaluate, and Share Impact of Postpartum Care Coordination Initiatives
States can evaluate postpartum care and care coordination programs on a variety of measures to assess the impact on maternal health outcomes, including awareness of postpartum coverage for both providers and beneficiaries, postpartum visit attendance, quality of care, model and delivery types, and clinical outcomes. In addition to clinical outcome measures, state Medicaid programs may consider partnering with Title V MCH programs to leverage and align data collection and evaluation approaches across programs.
- States can leverage the 2025 Centers for Medicare and Medicaid Services (CMS) Maternity Core Set to track the quality of care Medicaid members receive. CMS identified a core set of measures for reporting by state Medicaid and CHIP agencies. The core set consists of mandatory, voluntary, and provisional measures from the Child Core Set and Adult Core Set. These data will be used by CMS to measure and evaluate progress toward improvement of maternal and perinatal health in Medicaid and CHIP.
- “Postpartum Visits” is one of two Universal National Performance Measures (NPMs) for state Title V MCH Services Block Grant programs established in 2024. The Universal NPM for Postpartum Visits includes the percent of women who attended a postpartum checkup within 12 weeks after giving birth and the percent of women who attended a postpartum checkup and received recommended care components. States may also track and report on NPMs that include postpartum mental health screening and postpartum contraceptive use, as aligned with state-identified priorities. State agencies can leverage these data to align and monitor efforts to strengthen postpartum care.
Many states are working to improve maternal health outcomes against a backdrop of challenges, including shortages in the maternity care workforce. In addition to efforts to support this workforce through increased reimbursement rates and training additional frontline practitioners, states are implementing a range of Medicaid-financed care coordination initiatives. There are a variety of considerations in designing a care coordination program, including financing and reimbursement, expanding and connecting the workforce, developing connections to community and social needs providers, selecting the care coordination model to implement, and measuring outcomes.
Some states are supporting the maternity care workforce through increased reimbursement rates and investing in the mental health care and specialist care workforce to improve transitions to care during the postpartum period.
- North Carolina increased the Medicaid reimbursement rate for bundled maternity care and created an incentive payment for group prenatal care.
- New York increased the state’s Medicaid reimbursement rate for midwifery services from 85 percent to 95 percent of the physician fee schedule. The state also announced an initiative to support the maternal mental health workforce, securing funds in the governor’s budget to provide training on maternal mental health to a variety of frontline practitioners, including therapists, lactation consultants, WIC staff, home-visiting nurses, and counselors staffing the state’s crisis lifeline.
Additional Resources
Acknowledgments
This toolkit was written by Megan Lent and Anoosha Hasan. The authors would like to thank Anna Lipton Galbraith and Karen VanLandeghem for their contributions. This toolkit was made possible by the Pritzker Children’s Initiative.
