Maryland’s priority for the women's/maternal health domain is to ensure that women are in optimal health before, during and after pregnancy.

Maryland Title V provided preventive and primary care through direct, enabling and public health infrastructure services to a variety of women's/maternal health needs in FY24.

Services and activities focus on the needs of women across the Title V maternal and child health pyramid as outlined by the state action plan. Within the maternal health priority area, there are three focus areas in maternal health:

•        Focus Area 1: Oral health measured by the national performance measure -percent of women who had a preventive dental visit during pregnancy (formerly national performance measure 13.1).
•        Focus Area 2: Substance use prevention and linkages to care and measured with two performance measures:

1) Percent of women who smoke during pregnancy (formerly national performance measure 14.1)

2) Overdose Mortality Rate for women, ages 15-49 (formerly state performance measure 1)

•        Focus Area 3: Reduce rates and eliminate health differences in maternal mortality and morbidity with the state performance measure of reducing severe maternal morbidity rates, that aligns with the state priority tied to Maryland’s health care financial model called the “Total Cost of Care.”

 

Focus Area 1 - Oral Health

Percent of women who had a dental visit during pregnancy

According to Maryland 2023 PRAMS[1] data, 48.8 percent of mothers had a cleaning during pregnancy, similar to 49.0 percent in 2022. After an increase from 2021 (31.8 percent) to 2022 (36.0 percent), the proportion of Hispanic mothers receiving oral health care during pregnancy in 2023 decreased again to 30.3 percent. The percentage of mothers receiving oral health care during pregnancy continued to decrease among non-Hispanic Black women (from 46.3 percent in 2021 to 42.4 percent in 2022 to 37.2 percent in 2023). However, increases were seen among non-Hispanic white women (from 59.7 percent in 2022 to 66.6 percent in 2023) and among non-Hispanic Asian women (from 48.7 percent in 2022 to 68.7 percent in 2023). A decrease was seen among mothers with 12 or fewer years of education (38.1 percent in 2022 to 32.7 percent in 2023) while similar rates were seen among mothers with 13 or more years of education (55.0 percent in 2022 to 56.8 percent in 2023). From 2022 to 2023, decreases were seen among mothers 20 to 24 years of age (36.2 percent to 33.1 percent), mothers 25 to 29 years of age (44.4 percent to 37.4 percent), and mothers 30 to 34 years of age (58.0 percent to 55.6 percent), while an increase was seen among mothers 35 years or older (48.1 percent to 57.1 percent).

In FY24, $2,139,412 Title V funds continued to support programming to pregnant women at local health departments throughout the state. Thirteen of the 24 local health departments (Baltimore City, Baltimore County, Calvert, Caroline, Cecil, Frederick, Harford, Kent, Montgomery, St. Mary’s, Talbot, Wicomico and Worcester) used these core public health funds on maternal health enabling services, specifically perinatal care coordination and home visiting. All local health departments receive Title V core public health funds as mandated by House Bill 314 (enacted in 1995), and the local health departments can choose certain services that align with the state action plan and address the local maternal child health needs.

Key partners that work toward improving oral health include the Office of Oral Health within the Prevention and Health Promotion Administration, local health departments and local dental clinics. During FY23, the Office of Oral Health began producing a series of plain language educational materials in response to House Bill 290, passed in the 2023 Maryland legislative session. Dental services for postpartum patients were also expanded to cover up to 12 months after the end of a pregnancy, due to the expansion of Medicaid coverage up to one year postpartum, effective Apr. 1, 2022. 

A total of 837 pregnant women were referred to dental care by local health departments in FY24. Two home visiting programs, Healthy Families America and Child Health System Improvement, referred 93 and 26 pregnant women with dental care, respectively. Care coordination services linked an additional 718 women to dental care.

Focus Area 2: Substance Use Prevention and Linkages to Care

This focus area has two performance measures:

1. Percent of women who smoke during pregnancy (previously NPM 14.1).
2. State performance measure, Overdose Mortality Rate for women, ages 15-49 (SPM 1).

 

Performance Measure 1- Smoking during pregnancy

Both Maryland and the U.S. have seen a downward trend in the percentage of women who smoke during pregnancy since 2010. In 2023, which is the most recently available national vital statistics system data, 2.3 percent of women in Maryland smoked during pregnancy, which is lower than the national average (3.0 percent). The percentage of Maryland mothers who smoked during pregnancy decreased by 45 percent from 2020 to 2023. In 2020, 4.2 percent of Maryland women smoked during pregnancy. The percentage of Maryland women who smoked during pregnancy in 2023 was highest among non-Hispanic multirace women (4.6 percent) and non-Hispanic white women (3.7 percent). Additionally, 3.5 percent of American Indian or Alaskan Native women (regardless of ethnicity, both single and multi-race) in Maryland smoked during pregnancy.

During FY24, Title V continued the partnership with MDH’s Center for Tobacco Control and Prevention, which provides enhanced counseling services that motivate pregnant women to quit smoking. Counseling interventions provide motivation to quit and support to increase problem-solving skills. Counseling interventions may include motivational interviewing, cognitive behavior therapy, other psychotherapies, problem-solving and other approaches. Pregnant women are more likely to quit when cessation counseling is combined with motivational interviewing and is provided by a trained educator.

The Quitline, which is funded by MDH’s Center for Tobacco Control and Prevention, is a free service to all Maryland residents aged 13 and older. The program for pregnant women consists of seven coaching sessions with personalized content and up to twelve weeks of nicotine replacement therapy medications (with healthcare provider permission). Participants may call in for additional support at any time. Medication use is monitored to ensure use compliance and assess and problem-solve potential side effects. The quit coach assesses the participant’s status and progress, builds upon information previously gathered, identifies barriers and reinforces successes. Coaches have degrees in counseling or addiction treatment.

In FY24, the Quitline enrolled 98 pregnant women, 32 more compared to FY23 enrollment levels. Of those enrollees, 91 participated in the pregnancy rewards programs. The pregnancy rewards program encourages and supports pregnant women who use tobacco to engage in support from the Quitline. This incentive program offers rewards to women who complete each of the seven coaching sessions. Eligible callers receive $25 gift cards to Target per completed session for a maximum of $175 per participant for completing all seven sessions.

The Title V grant funds local health departments through perinatal care coordination and home visiting services to routinely screen women for tobacco use and offer referrals to the state’s Quitline. Staff who screened respondents were from home visiting, home birth certification, early intervention, and family planning clinics. In FY24, 114 women were referred to tobacco cessation programs, including the Quitline. This is still a sustained decrease compared to referrals in FY20, when a total of 892 prenatal/postpartum women were referred to tobacco cessation programs and is consistent with the overall decreases in referrals to services due to COVID-19. The state is currently revisiting its perinatal care coordination efforts to better understand referral trends and support needed.

Performance Measure 2- Overdose Mortality Rate for women of reproductive age (SPM 1)

Data from the annual 2022 Maternal Mortality Review Report showed that unintentional overdose was the leading cause of pregnancy-associated deaths in Maryland at 38 percent in 2020 (the 2022 report has 2020 data and is the most recently available from the Maryland Maternal Mortality Review Program). According to the Maryland Behavioral Health Administration, it is estimated that 275 pregnant women with opioid use disorder received opioid maintenance treatment in 2024.

Incident characteristics of overdose deaths can be found in the annual Maternal Mortality Review Report. In Maryland, from 2011-2020, there were 114 overdose-related pregnancy-associated deaths, with 82 (72 percent) non-Hispanic white women and 24 (21 percent) non-Hispanic Black women. On average, these overdose deaths occurred 192 days postpartum. Fourteen women, representing 12 percent, had not initiated prenatal care.

In December 2023, the state’s designated office to coordinate overdose response and prevention efforts was renamed from the “Opioid Operational Command Center” to the “Office of Overdose Response”. The Office integrates the state’s overdose response work into the Maryland Department of Health to better reflect the state’s public health approach to overdose prevention. The Office’s dashboard is now housed at https://health.maryland.gov/dataoffice/Pages/mdh-dashboards.aspx to provide monthly updates on information to coordinate activities around preventing overdose deaths. Data for calendar year 2024 show 1768 deaths, 314 of which were among women of reproductive age (under 25-54 years).

 

Strategies to decrease overdose fatalities due to unintentional opioid use

Substance use is a leading cause of maternal death and has a significant impact on the approximately 1,500 infants born to Medicaid participants with opioid use disorder (OUD) in Maryland per year. Medicaid launched the MOM Program, which addresses fragmentation in the care of pregnant and postpartum Medicaid participants with OUD through enhanced case management services, with an emphasis on increasing health service utilization, as well as screening and referral for unmet community needs. Initially funded as part of a Center for Medicare and Medicaid Innovation demonstration, the MOM program has supported efforts in increasing provider capacity to treat the maternal OUD population. As of January 1, 2023, Maryland has ceased its participation in the federal CMMI demonstration; implementation of MOM case management services continued seamlessly. At this time, the MOM program became available statewide, open to all eligible HealthChoice members. As of the end of September 2024, there have been 106 participants in the MOM program. Program participants to date have demonstrated an interest in engaging in treatment for their OUD, as well as efforts to change life circumstances, including enrolling in educational courses, learning to drive and securing stable housing. The program experienced a sharp increase in enrollment following the statewide expansion.

The Department partnered with two organizations - the Maryland Addiction Consultation Service and Bowie State University–to augment MOM’s impact. Through the partnership, MACS continued the MACS for MOMs program to build provider capacity to better treat the maternal OUD population. The program includes teleECHO clinics, a warmline for phone consultations, and a variety of training, including those for receiving a DATA 2000 Waiver, which allows providers to prescribe buprenorphine. To strengthen the MOM program by making it more attractive to communities of color, the Department partnered with Historically Black Colleges and Universities, led by Bowie State, to tailor the program to be more culturally responsive to Maryland’s Black population.

Bowie State University finished its research in December 2023. Their study examined wrap-around social service providers who were outside of the MOM program, but who have successfully recruited and retained women from similarly stigmatized populations. Many participants praised the MOM program and expressed beliefs about its value and potential to be impactful to the clients it aims to serve. Funding for MACS for MOMs has since transitioned over to MCHB. MACS for MOM is conducting a needs assessment to understand what further challenges and resources are needed. The final report was shared with MDH in November 2024. 

In 2023, the MACS for MOMs enrolled 642 practitioners in their services, consulted on 58 perinatal calls that were received during the warmline, hosted four webinars with a total of 302 attendees and hosted 11 teleECHO clinics with 161 total attendees.

While Title V funds did not fund MACS for MOMs services, Title V local health department staff shared these resources with other clinical providers in the state. Furthermore, Maryland’s Title V program partnered with the MOM team to expand referrals to the local health departments and managed care organizations via Maryland prenatal risk assessment form (MPRA). The form assesses medical and social needs and connects the pregnant woman to special needs coordination with the managed care organization and also perinatal care coordination through local health departments (that are often funded through Title V). Under regulation COMAR 10.09.68.05, the Maryland prenatal risk assessment should be completed for Medicaid participants at the first prenatal care visit. Specifically, Maryland’s Title V program has emphasized the importance of the MPRA during the local health department technical assistance calls. Maryland is using separate funding through the Integrated Maternal Health Services grant from HRSA to digitize the MPRA and to coordinate the various Title V-funded services to which pregnant women are connected. Title V leveraged CDC’s Overdose Data2Action federal grant to fund the Montgomery County Health Department to conduct relationship-building activities at local birthing hospitals to educate clinical staff on the MPRA and another form, the Postpartum Infant and Maternal Referral Form (PIMR). The demonstration was successful, with a 7 percent increase in receipt of PIMR forms. Additionally, the CDC’s Overdose Data2Action grant was used to fund a landscape analysis to understand the capacity and role of peer navigators (home visitors, care coordinators, community health workers) to connect pregnant and postpartum women to harm reduction and behavioral health services. Finally, the CDC funds continued to be used to support the Medicaid MOM model described above.

 

Maryland Family Planning Program- Screening, Brief Intervention, and Referral to Treatment

The Maryland Family Planning Program values the holistic approach to health service delivery, while noting that family planning service sites often function as the sole source of health care for some populations. The MFPP implemented a comprehensive program-wide training to implement the Screening, Brief Intervention, Referral and Treatment (SBIRT) initiative in fiscal year 2021 and developed a means for data collection for evaluation. SBIRT activities are mandated through policies with the MFPP, as the HRSA Title X grantee, while service delivery is provided through collaborations with 22 subrecipients who executed SBIRT at 63 service sites across Maryland.

In FY24, the MFPP provided services to over 43,000 new and continuing care clients. In that time, there were 2,139 SBIRT screenings provided and 30 positive SBIRT evaluations for clients who were referred for further services. All MFPP subrecipients are tasked with identifying and developing resources to support the referral process. Also, in FY24, the MFPP was able to award funding for special initiatives designed by subrecipients, including one site that specifically focused on increasing service provision to those seeking substance misuse treatment.  

 

Babies Born Healthy Initiative

During FY24, eight local jurisdictions implemented state-funded Babies Born Healthy (BBH) perinatal care coordination, which directed resources to engage women and communities to provide supportive coordinated care and address health differences in infant mortality rates in Maryland. BBH is funded by Title V’s state-matched funds. In FY24, a total of 1,268 families were newly enrolled in BBH, and 1,729 families accessed BBH services. The sites (Baltimore City, Baltimore, Prince George’s, Anne Arundel, Charles, Caroline, Montgomery and Wicomico counties) were selected to receive funding because they have the largest demographic health differences in infant mortality, particularly in the non-Hispanic Black population, as compared to the non-Hispanic white population.

All program participants are assessed for resource needs, connected to resources and provided resources on a wide variety of topics, including but not limited to: WIC and food security, prenatal care, health insurance and infant safe sleep. BBH sites also provided linkages to care for further treatment for those who are experiencing substance use or opioid use disorder or had perinatal mood and anxiety disorders. All BBH sites provide extended care coordination for 6 months to a year postpartum for program participants who require substance use and/or mental health support. One BBH site, the Anne Arundel County Health Department, convened a substance-exposed newborn multidisciplinary group, which works closely with the local HealthyStart program to make recommendations to support and conduct outreach for families of substance-exposed newborns and pregnant women who are experiencing substance use disorder.

Focus Area 3: Reduce rates and eliminate health differences in maternal mortality and morbidity

This focus area is tied to the state performance measure (SPM 2) that aims to reduce non-Hispanic Black to non-Hispanic White severe maternal morbidity gaps. In addition, this focus area is linked to the national outcome measure of severe maternal morbidity (previously NOM 2) and maternal mortality (previously NOM 3).

Based on data for January to December 2024, the state’s severe maternal morbidity rate (including blood-transfusion-only events) is 316.9 events per 10,000 delivery hospitalizations according to the Health Services Cost Review Commission. This rate represents a 30 percent increase, or an additional 73.8 hospitalizations per 10,000 deliveries, compared to the 2018 baseline. Severe maternal morbidity rates were highest among non-Hispanic Black women at 426.8 per 10,000 deliveries, a 28 percent increase from the 2018 SIHIS baseline of 334.2 events per 10,000 deliveries.

Maryland’s Title V program works to achieve this focus area through a life-course approach. During FY23/FY25 Title V reporting period, the department began monitoring self-reported postpartum visit attendance. For the FY24 annual report, Maryland had selected postpartum visits and smoking during pregnancy (NPM 13.1 and 14.1), as outlined in the state action plan table. According to Maryland 2023 PRAMS[2] data, pregnant women reported attending postpartum visits at high rates. Nearly 93 percent of parents reported attending a postpartum check-up.

Maryland expanded Medicaid

As of Apr. 1, 2022, Maryland expanded the duration of postpartum coverage for Medicaid participants from 60 days to one year after the end of pregnancy. This policy change ensured that Medicaid participants who are eligible for services due to their pregnancy status are able to continue their coverage without concerns of income or household size fluctuations. This expanded coverage is anticipated to continue enhancing the overall well-being of mothers and their children in Maryland.

Additionally, in 2022, the Maryland General Assembly passed legislation which expanded coverage for pregnant and postpartum Marylanders. This law went into effect on July 1, 2023. In FY24, 12,872 pregnant and postpartum women were able to receive comprehensive coverage as a result of the law.

As background, this state performance measure is a population health goal tied to Maryland’s health care financial model called the Total Cost of Care model. As part of the model, the state’s proposal to the CMMI focused on population health goals, including having goals related to maternal and child health. In FY21, CMMI approved the state’s proposal to focus on severe maternal morbidity and asthma. This model is currently set to end in December 2025.

Strategies to reduce rates and eliminate health differences in maternal mortality and morbidity

Overall, Title V and members of the Maternal Health Improvement Task Force developed a Statewide Maternal Health Improvement Program Strategic and Action plan in 2021.  Please see the plan here. The plan uses a life course approach. Please see below for further information on Title V contributions to improve maternal health in the state as well as more information on the Maryland Maternal Health Innovation Program.

 

Maternal Mortality Review Program

The Maternal Mortality Review program reviews all pregnancy-associated deaths, defined as deaths during or within one year after the end of a pregnancy from any cause. The program is fiscally supported mostly through CDC’s Enhancing Reviews and Surveillance to Eliminate Maternal Mortality grant and state Title V match general funds. However, Title V staff, specifically the maternal health manager, oversee the program with support from the bureau’s director, medical director, and office director.

Based on the most recent public data, which is the 2022 report that contains data from 2020, there were 58 pregnancy-associated deaths in 2020, resulting in a pregnancy-associated mortality rate of 84.6 deaths per 100,000 live births. The number was higher than in previous years. Of the 58 pregnancy-associated deaths, 17 were determined to be pregnancy-related, for a pregnancy-related mortality rate of 24.8 deaths per 100,000 live births. Among the 17 pregnancy-related deaths in 2020, the leading causes of death were behavioral health conditions (n=5), cardiovascular conditions (n=3), and infection (n=3). The remaining pregnancy-related deaths were single cases of cancer, pulmonary conditions (excluding acute respiratory distress syndrome), injury, collagen vascular/autoimmune diseases, thrombotic embolism, and metabolic/endocrine conditions.

Of the 17 pregnancy-related deaths occurring in 2020, six cases (35 percent) involved non-Hispanic white women, nine cases (53 percent) involved non-Hispanic Black women, and two cases (12 percent) involved Hispanic women. Among the 41 non-pregnancy-related deaths, 18 cases (44 percent) involved non-Hispanic white women, 18 cases (44 percent) involved non-Hispanic Black women, four cases (10 percent) involved Hispanic women, and one case (2 percent) involved a non-Hispanic women whose race was identified as other. The rate of pregnancy-related deaths in non-Hispanic Black women was 2.0 times higher than that of non-Hispanic white women.

The findings from the MMR Team provided recommendations to the state legislature and the Maryland Department of Health at large. These recommendations emphasized the need to partner with community-based organizations and further expand programs such as home visiting and ensure there are warm referrals from the transition of the birthing hospital to home. Further information on the Maternal Mortality Review Report can be found on the Maternal and Child Health Bureau webpage here: https://health.maryland.gov/phpa/mch/pages/mmr.aspx. In FY24, the MMR Program also developed an action arm to implement several of these recommendations. The state funded three LHDs (Baltimore City, Charles and Dorchester Counties) to support local efforts to prevent maternal mortality and support maternal health. Funded activities included health promotion and education, provision of doula services, training on prenatal and postpartum behavioral health conditions, incentives for prenatal care participation, and more. In May 2024, the MMR Program also hosted its first-ever Maternal Mortality Summit in FY24.

The Maryland MMR program has focused increased attention on health differences in pregnancy-associated deaths. In 2018, the Maryland General Assembly enacted legislation to establish a maternal mortality stakeholder group composed of the Maryland Office of Minority Health, the Maryland Patient Safety Center, the Maryland Healthy Start Program, women’s health advocacy groups, community organizations, local health departments, health care providers serving minority women and families that have experienced a maternal death. This stakeholder group is tasked with reviewing the findings and recommendations in the annual MMR Report, examining issues resulting in health differences, and identifying new recommendations with a focus on health differences in maternal deaths.

In 2024, the stakeholder group met twice. The first meeting was to review the results of the 2021 deaths, and the last meeting was to develop their accompanying recommendations. This data has not yet been published, but there continues to be a trend of demographic health differences in pregnancy-related mortality rates for pregnant Black women compared to pregnant white women. The recommendations of both the MMRT and the Stakeholder groups will be included in the 2023 MMR report.

 

An Update on the Statewide Integrated Health Improvement Strategy Public Health Funding Initiative

Through additional funding from HSCRC’s Maternal and Child Health Population Health Improvement Fund (or the Fund), MDH pursued a competitive procurement in FY22 to expand evidence-based and promising practice models of home visiting and/or perinatal care coordination. While these grant funds are through specialized funds and are not part of the Title V match, Title V staff coordinate the use of these funds.

Based on feedback from stakeholders, the funds were focused on promising practices of home visiting. Promising practice programs offer innovative solutions and allow for flexibility and adaptation based on data, as they are not bound by the strict protocols of evidence-based programs. Four sites (Montgomery and Washington county health departments, Baltimore Healthy Start and Baltimore City-based The Family Tree) were selected and began work in FY23. In FY24, reporting was changed to better capture screening and referral activities. A summary of their inaugural year activities by site can be found below.

Montgomery County Health Department

The county expanded its BBH initiative to connect its participants to its long-term home visiting services. The program offers the March of Dimes’ “Becoming a Mom” curriculum for all BBH participants who wish to participate through group classes or individual sessions. This program enhances maternal understanding through a collaborative community-based model of care. The program focuses on providing services to a number of high-risk zip codes in Montgomery County, which include: 20903, 20904, 20906 and 20912. At baseline, the Montgomery County BBH program enrolled approximately 125 families. With HSCRC funding, the program was able to expand to enroll 31 families in their first year of implementation. In FY24, the BBH program enrolled 63 new participants.

Washington County Health Department

The county began the expansion of their existing home visiting services via the local program affiliate, Healthy Families America, which is currently funded by the Maryland Maternal, Infant, and Early Childhood Home Visiting Program. Healthy Families America has an intensive home visiting program in which families are offered services for a minimum of three years and are visited weekly when families first enter the program.[3] The program enrolled 26 new families from both streams of funding (HSCRC and MIECHV), with four (15 percent) of those families being attributed to HSCRC fund-supported home visiting expansion. The program successfully organized and conducted three virtual family groups, with an average monthly attendance of 18 families. The virtual family groups have facilitated meaningful connections among families, provided essential parenting insights, and created a platform for the sharing of experiences. In 2024, the Washington County program enrolled 29 new families, 6 of which (20 percent) can be attributed to the HSCRC fund.  

Baltimore Healthy Start

Baltimore Healthy Start collaborated with Chase Brexton Glen Burnie Health Center and the administrative care coordination unit of the Anne Arundel County Department of Health to expand home visiting services to prenatal and postpartum women in the areas serviced by Chase Brexton Glen Burnie Health Center. This includes zip codes: 20724, 21060, 21061, 21225, and 21226. This initiative utilized the “Great Kids” curriculum, designed for home visits from the prenatal period to when a child reaches 36 months of age. Families are offered standard BHS case management and care coordination services through the Chase Brexton-based Medication Assisted Treatment for Substance Use Disorder program. This program intends to provide services to 40 additional families annually. In 2023, they served 24 families and enrolled one new family in 2024. Numbers are lower than the target due to challenges with staffing, which MDH has provided support and assistance around, in partnership with our MIECHV programs. In summer 2024, BHS shifted its partnership from Chase Brexton Glen Burnie to Total Health Care, with which it has existing relationships in Baltimore City. In FY25, BHS will use an additional supplement to increase capacity.

The Family Tree

The Family Tree facilitated the expansion of home visiting services in Baltimore City through the “Parents as Teachers” model. Home visitors conduct regular visits, supporting families from pregnancy through their child’s kindergarten year.[4] It is designed to build skills, capacities and confidence; the program gives families access to qualified parent-educators who can provide high-quality, reliable, home visits and parent engagement activities.[5] The PAT curriculum addresses critical areas including: mental health, nutrition, maternal depression, substance use and domestic violence. In FY23, the program received certification to operate as a PAT-affiliated site from the Parents as Teachers National Center and successfully recruited and onboarded staff to empower the growth of the PAT home visiting initiative. The program's collaborative efforts extended to partnerships with Health Care Access Mayland, Urban Strategies and The Parent Helpline. In 2023, the program successfully enrolled 26 families into the PAT program for home visiting, and in 2024 they enrolled an additional 15 families. Due to staffing issues, Family Tree has had challenges meeting data reporting requirements. MDH is working with the grantee to provide assistance and streamline data collection.

Collectively in FY24, HSCRC fund-supported home visiting expansion initiatives enrolled over 85 families in priority jurisdictions despite sites describing recruitment and staffing challenges. Table 1 indicates the number of those enrolled by race and ethnicity and Table 2 indicates the number of enrolled by insurance provider.

Table 1: Number Enrolled in SIHIS Home Visiting Expansion by Race/Ethnicity in Federal Fiscal Year 2024 

 

Table 2: Number Enrolled in SIHIS Home Visiting Expansion by Insurance Provider in Federal Fiscal Year 2024

 

 

Expanding Group Prenatal Care in Maryland

Another major strategy for Maryland is to expand the “CenteringPregnancy” model. The CenteringPregnancy group prenatal care model follows the traditional recommended schedule of ten prenatal visits, but with the difference that each visit is 90 to 120 minutes long. This model gives pregnant patients ten times the length of interaction with providers when compared with the average amount of interaction time in traditional prenatal visits. Moreover, the model allows for the patient to take their own weight and blood pressure and to record their own health data during the visit.[7] This interactive approach empowers patients and fosters a sense of efficacy in managing their health. After the health assessment is completed, eight to 10 pregnant women gather with a provider to be a part of interactive activities designed to address important and timely health topics. CenteringPregnancy is shown to be effective in reducing birth outcome health differences among non-Hispanic Black pregnant women, who disproportionately experience adverse maternal health outcomes.[8],[9]

The Maryland Department of Health is currently supporting the expansion of ten CenteringPregnancy sites through public health startup funds, in partnership with Maryland Medicaid. In FY23, specialized funds from SIHIS were used to provide these public health startup funds. While SIHIS funds are not part of the Title V match, Title V staff coordinated the expansion of CenteringPregnancy. In FY24, PHPA/MCHB combined additional public health funding from the Babies Born Healthy Program to provide support for three additional sites. The funding from the BBH Program is used as a Title V match. All Centering sites are eligible to apply for enhanced reimbursement from Maryland Medicaid to support program sustainability.

Mercy Health Foundation received funding in late FY22, launching CenteringPregnancy at one of its OB/GYN practices in downtown Baltimore City. In FY23, the site successfully conducted 15 cohorts and 78 CenteringPregnancy classes benefiting 87 pregnant patients, with a third of the participants completing the CenteringPregnancy classes. In FY24, the site conducted 16 cohorts benefiting 106 pregnant patients. Mercy Health achieved “Centering site” accreditation for CenteringPregnancy in July 2024.

In June 2022, MDH partnered with the Centering Healthcare Institute, resulting in a successful recruitment and provision of startup funds for implementing the CenteringPregnancy model in four prenatal clinics, strategically located in Baltimore County, Montgomery, and Prince George’s counties. Utilizing the braided funding, Centering Healthcare Institute recruited an additional four sites in FY24, located in Baltimore City, Frederick, and Montgomery counties:

•        Kaiser Gaithersburg in Montgomery County.
•        Mary’s Center in Montgomery County.
•        University of Maryland St. Joseph’s Women’s Health Associates in Baltimore County.
•        Luminis Health in Prince George’s County.
•        Frederick Health in Frederick County.
•        Baltimore Medical System at Yard 56 in Baltimore City.
•        CCI Health Silver Spring in Montgomery County.
•        Lifebridge Sinai Hospital in Baltimore City.

 

In 2024, Mary’s Center in Montgomery County stopped Centering models due to organizational changes. All four new sites are developing their Centering Implementation Plan, which incorporates processes and tools to help sites identify and address barriers. The CIP aims to position the site to successfully complete the accreditation process. Over 4-6 months, CIP collaborates with each site on the following areas:

1. Creating the steering committee
2. Engaging leadership
3. Building a shared vision
4. Goal setting and evaluation
5. Creating a centering schedule
6. Create a centering space in the clinic
7. Patient enrollment
8. Provider productivity
9. Financing and budgeting
10. Billing and reimbursement

In FY24, CIP provided training, coaching, technical assistance and tools from CIP expert consultants. During the first three months, a CIP consultant guides the first steering committee meeting and provides guidance through the startup process. Within six months, sites typically introduce their first cohort of participants. In twelve to eighteen months, sites obtain their Centering Accreditation. In October 2023, CIP convened a second Centering Consortium of Maryland to increase awareness with health organizations about the opportunities for the three available grants to implement the CenteringPregnancy model group for prenatal care. The Centering Consortium was also attended by both Maryland Medicaid and MCHB, which provided an opportunity for all parties to discuss and strengthen implementation.

Title V Partnerships with the State Maternal Health Innovation Program

Title V partners with the recipient of the HRSA’s State Maternal Health Innovation Program, Johns Hopkins University. The JHU-led initiative, MDMOM, was renewed for another five years (October 2023 through September 2028) to continue its work in implementing various maternal health innovations in the state. Title V staff members coordinate the Maternal Health Improvement Task Force (the Task Force) as part of the MHI grant and provide overall guidance to JHU and its partners.

In FY24, the Task Force and Title V staff continued work on two projects:

1. Building a map of providers and resources in Maryland to support maternal health.
2. Preparing an update to the Maternal Health Improvement Strategic Plan (the Strategic Plan), originally completed in 2021.

The Task Force originated the Maryland Maternal Health Resource Map to better understand the network of maternal health partners and services across Maryland. In FY23, the Task Force developed the idea and initial survey; they continued this work in FY24 with JHU and their contracted web developer to build out an interactive map. The interactive map displays resources and services available to pregnant and postpartum families in Maryland. JHU will continue updating the map periodically for the duration of the MHI grant.

As part of the new MHI grant, the Task Force is required to prepare a strategic plan outlining maternal health priorities for Maryland. Since FY23 the Task Force has been updating its existing 2021 Maternal Health Strategic Plan (SP 1.0). The SP 1.0 has five main focus areas to improve maternal health:

1. Understand current needs in maternal health.
2. Achieve health (preconception, prenatal and birth, postpartum and interconception periods) using the Life Course Model to support Maryland pregnant women through advocacy and implementation of effective policies.
3. Develop strategies that acknowledge the influence of the community health factors to improve resiliency for pregnant women, families, and communities and to promote an optimal quality of life.
4. Improve access and utilization of data to understand health impacts among different populations and its impact to make informed decisions.
5. Develop a comprehensive maternal health provider workforce.

As part of its update, the Task Force revisited each of the five focus areas and their associated objectives and tactics to ensure they are comprehensive and aligned with maternal health needs in Maryland. Members used Dr. Monica McLemore’s “Retrofit, Reform, and Reimagine” framework to evaluate the strategic plan components in a way that considers the needs of different populations In Spring 2024, the Task Force and Title V staff began working with the Maternal Health Learning and Innovation Center (MHLIC), HRSA’s designated technical assistance provider to MHI grantees.

We anticipate the revised Strategic Plan will be finalized in Fall 2025.

The Department continues to pay the co-chairs for their time related to task force activities. This was at the suggestion of subject experts and members to ensure that the co-chairs are able to participate. Title V staff were successfully able to establish a mechanism to pay the co-chair.

For more information about the various partnerships, please review the MCH Partnerships and Collaborations document for more information on various partnerships.

Maryland Perinatal Quality Collaborative

Maryland’s Perinatal Quality Collaborative is a network of perinatal care providers and public health professionals working to improve health outcomes for women and newborns through continuous quality improvement. The collaborative provides participating birthing hospitals with educational resources, technical assistance and a platform for communication and sharing of best practices.

During FY24, the MDPQC began implementing its next maternal bundle focused on obstetrical hemorrhage. The MDPQC steering committee, which consists of perinatal care providers and public health professionals, worked with birthing hospitals to select obstetric hemorrhage as the next area of focus beginning July 1, 2023. Obstetric hemorrhage is one of the leading causes of maternal mortality and severe maternal morbidity in Maryland. This initiative capitalizes on another AIM Patient Safety Bundle with a focus on prevention, early identification and rapid response to obstetric hemorrhage. Bundle components also focus on how hospitals can support a pregnant woman who has experienced an obstetric hemorrhage and their family after the event.

As of September 2024, all 32 birthing hospitals were participating in the new bundle implementation. Participants showed positive growth in increasing implementation of the seven core measures (patient event debriefs, clinical team debriefs, multidisciplinary case reviews, patient education on warning signs, hemorrhage cart, unit policies and procedures, and quantitative blood loss measurement) between October and December 2023 (most recent data submitted as of October 2024). The MDPQC also continued sustaining its maternal hypertension bundle, which ended active implementation in June 2023. Through that bundle, the hospitals implemented a bundle of interventions that included best practices for preventing, identifying and responding to a pregnant woman experiencing high blood pressure. The combined efforts led to a 59.1 percent improvement across all hospitals in the timely treatment of elevated blood pressures. This was defined as the administration of the appropriate treatment within 60 minutes of identification of the elevated blood pressure. This included a 79.3 percent improvement in the timely treatment of elevated blood pressures for non-Hispanic Black pregnant women.

MDH was also awarded a supplemental grant from HRSA to support implementation of AIM bundles in birthing hospitals. In February 2024, MDH began partnering with a non-profit organization, the Bloom Collective, to provide technical assistance and training to birthing hospitals. In June 2024, the Bloom Collective conducted five regional training sessions to discuss quality improvement work and strategies to understand the needs of communities birthing hospitals serve. Seventy-four individuals representing birthing hospitals, local health departments, community birth workers, academia, state government and other maternal health-focused organizations attended. The Bloom Collective is currently working with hospitals to organize and conduct in-person half-day workshops at birthing hospitals across Maryland to provide specific support through focused training, capacity building and technical assistance for specific projects or interventions identified by the birthing hospital. These sessions are scheduled throughout 2025.

[1] Maryland PRAMS 2021-2023 data should be interpreted with caution due to low response rates.

[2] Maryland PRAMS 2021-2023 data should be interpreted with caution due to low response rates. Further, 2023 PRAMS data was collected using the Phase 9 PRAMS questionnaire, which frames questions relating to postpartum visits slightly differently than in previous years. Thus postpartum visit data from 2023 onwards is not directly comparable to data from 2022 and prior.

[3] Healthy Families America. https://www.healthyfamiliesamerica.org/our-approach/#:~:text=Home percent20Visiting,-Should percent20home percent20visiting&text=Most percent20families percent20are percent20offered percent20services,trusting percent20relationships percent20with percent20participating percent20families.

[4] Most home visitors (72 percent) have a bachelor’s degree or higher. The PAT mode requires a high school diploma or GED plus 2 years of experience working with young children and/or parents for home visitors. https://nhvrc.org/model_profile/parents-as-teachers/#:~:text=PAT percent20was percent20implemented percent20by percent204 percent2C127,or percent20parents percent20for percent20home percent20visitors.

[5]  The Family Tree. https://www.familytreemd.org/parentsasteachers/

[6] Total number who have enrolled in the SIHIS Home Visiting Program

[7] Centering Healthcare Institute. https://centeringhealthcare.org/what-we-do/centering-pregnancy. Accessed 8 December, 2023

[8] Crockett, A. H., Chen, L., Heberlein, E. C., Britt, J. L., Covington-Kolb, M. S., Witrick, M. B., Doherty, M. E., Zhang, L., Borders, A., Keenan-Devlin, L., Smart, M. B., & Heo, M. (2022). Group versus traditional prenatal care for improving racial equity in preterm birth and low birthweight: the Cradle randomized clinical trial study. American Journal of Obstetrics and Gynecology.

[9] CHI. CenteringPregnancy and CenteringParenting Annotated Bibliography. December 2022.   https://www.centeringhealthcare.org/uploads/files/Centering-Healthcare-Institute-Annotated-Bibliography.docx-16.pdf