Postpartum Visit (FY 2026 Application)
Comprehensive, patient-centered postpartum care is important in assuring the physical, social and emotional well-being of women following birth. Attending a postpartum visit allows for assessment of critical health concerns, such as hypertension, hemorrhage, depression and anxiety, substance use, chronic disease, infant feeding and social support. These factors can have a significant impact on birth outcomes for both the mother and the infant.
The timing of postpartum visits is also important. The American College of Obstetricians and Gynecologists (ACOG) recommends that all individuals have contact with their provider within the first three weeks postpartum followed by a comprehensive postpartum visit within 12 weeks after birth.[1] This is critical because in Michigan, during the years 2017-2021, 38.6% of pregnancy-related deaths occurred 1-42 days postpartum and 38.6% of pregnancy-related deaths occurred 43 days or more postpartum. Additionally, 79.5% of pregnancy-related deaths were considered preventable[2]. It is unclear if the women captured in these statistics received postpartum care or not, but a comprehensive postpartum visit within three weeks of giving birth allows providers to assess for vital health indicators. Addressing the Postpartum Visit National Performance Measure (NPM) aligns with the state priority need to ‘Improve the quality and accessibility of respectful care before, during, and after pregnancy.’
From 2017-2021, Michigan saw a decline in the percentage of mothers attending postpartum visits within 12 weeks of giving birth from 91.2% in 2017 to 87.6% in 2021, as reported by PRAMS respondents[3]. However, in 2022, the percent of mothers reporting postpartum visits increased. Black women in Michigan are over two times as likely to die from pregnancy-related causes as White women. Therefore, closing the care gap is essential for improving maternal mortality rates in the state.
As mentioned above, the postpartum visit serves as an important touchpoint for discussions related to health needs and concerns. In 2022, 82% of PRAMS respondents reported attending a postpartum visit and being asked about recommended care components (e.g., contraception and mental health concerns) at the visit. This number is up from 2021 in which only 76.2% of respondents stated they were asked about contraception and mental health concerns during their postpartum visit.
As part of the Title V needs assessment, community listening sessions, focus groups, and provider surveys were conducted. Themes related to the postpartum period were evident across all methods of information gathering. Overarching themes relevant to this NPM include: the need for patient-centered care and the need for increased focus on postpartum period and postpartum mental health. To further expand upon these themes, families and community partners echoed similar sentiments: challenging issues and patient needs are not being addressed during postpartum visits; during the prenatal period providers should prepare patients for the postpartum period and stress the importance of postpartum visits; providers should acknowledge and educate patients on the urgent warning signs; and providers should assure they are providing respectful care. The strategies associated with this NPM’s objectives are aimed at addressing these concerns.
Michigan’s Healthy Moms, Healthy Babies initiative was a catalyst that led to expanded Medicaid coverage to 12 months postpartum. Expanding coverage helped address significant gaps in care and supports the health and well-being of postpartum women and their infants. The Healthy Moms, Healthy Babies initiative also supported Medicaid coverage for doula services and expanding evidence-based home visiting. Home visiting has been shown to increase the likelihood of a mother to attend a postpartum visit with a healthcare provider. Additionally, access to home visiting services was identified as a dominant strength through the listening sessions that were included as part of the Title V needs assessment.
Further evidence of the importance of postpartum visits can be gleaned from infant and maternal mortality case reviews. Recommendations are crafted based on circumstances surrounding the cases. Aligned Fetal Infant Mortality Review (FIMR) and Maternal Mortality Review Committee (MMRC) recommendations include increasing the utilization of wraparound services and support people as well as ensuring that postpartum visit appointments are made and kept. Additional recommendations from FIMR case reviews stress ensuring reimbursable postpartum visits via phone or in-person office visits, securing insurance coverage for additional postpartum care, and improving assessments of postpartum needs. Many of the strategies attributed to this NPM address the concerns named within these recommendations.
Title V funding is used to support Michigan PRAMS and FIMR, both of which provide data and recommendations related to postpartum visits. The Regional Perinatal Quality Collaboratives (RPQCs) receive Title V dollars as supplemental funds. The RPQCs promote many of the initiatives identified as strategies for this NPM, including but not limited to Centering Pregnancy, universal mental and behavioral health screenings, urgent maternal warning signs, and home visiting. They also engage family and community members and garner feedback across many topics.
Group prenatal care, as mentioned above, has emerging evidence to support improvements in birth outcomes for infants, as well as evidence that Medicaid beneficiaries who participate in several group prenatal care visits are more likely to attend a postpartum visit. Participants in Title V needs assessment focus groups also identified providers who prepare patients for the postpartum period during their prenatal care as a significant strength. The group prenatal care model implemented most often in Michigan is Centering Pregnancy. This objective supports the pillar ‘advance strategies so all children and families can flourish, as this model of care is evidence-based, patient-centered, inclusive of the mothers’ support people, and has been shown to yield positive outcomes for priority populations. Data provided on the Centering Healthcare Institute (CHI) website states that Michigan currently has 35 sites offering the Centering Pregnancy model of group prenatal care.
The first strategy for this objective is to support recruitment of new Centering Pregnancy sites throughout Michigan. This strategy is also the ESM for this performance measure. MDHHS has partnered with CHI to provide guidance to interested prenatal care sites, as well as promote the model of care to providers. While recruitment of individual sites will continue, attention is also being given to hospital systems and federally qualified health centers (FQHCs) as potential new Centering Pregnancy sites. Based on current research, it is expected that as the number of sustainable Centering Pregnancy sites increase across the state, the percentage of mothers who attend a postpartum visit within 12 weeks of giving birth will also increase. The total number of Centering Pregnancy sites in Michigan will be frequently monitored.
Sustainability of new and existing sites will be supported in part through ongoing enrollment in this care model. Increased enrollment is the second strategy for this objective and will be achieved as MDHHS and CHI staff continue to present positive outcomes and benefits of group prenatal care at speaking engagements and through marketing tools aimed at pregnant women. The tools are meant to raise awareness about this model of care, as well as encourage pregnant women to enroll in a participating program. As group prenatal care becomes a well-accepted model, the number of pregnant women who enroll in a Centering Pregnancy program is expected to increase. This, in turn, is expected to yield more mothers successfully completing care through a group prenatal care model, as well as increase the number attending a postpartum visit.
Michigan Medicaid provides enhanced reimbursement for Centering Pregnancy by paying for up to 12 Centering group visits, including a postpartum group visit. If an individual postpartum visit is required, it will also be reimbursed. MDHHS and CHI will explore adding the coverage with commercials payors through discussions with payors and partners. As commercial payors provide direct reimbursement of Centering, prenatal sites will be more likely to offer Centering Pregnancy care as an option for their patients.
Objective B: By September 30, 2030, increase the percentage of women who attend a postpartum visit from 90.2% to 94%.
As discussed above, postpartum visits are vital to the health and well-being of mothers and their infants. Different aspects of care, including awareness of the importance of postpartum visits, utilization of standard screening tools, awareness of urgent health warning signs, and home visiting support are integral to improving rates of quality and timely postpartum visits, as well as decrease maternal mortality and morbidity rates. The strategies listed below are aimed at different aspects of care which in turn are expected to increase the percentage of women who attend a postpartum visit within 12 weeks of giving birth. This objective addresses the pillar ‘advance strategies so all children and families can flourish’. Quantitative and qualitative data are used to shape strategies aimed at improving attendance at postpartum visits.
MDHHS partners and collaborates with several internal and external partners to further the efforts of improving birth outcomes. These partnerships support the pillar ‘foster collaboration to strengthen coordinated systems’ through building awareness of programs and services, implementation of universal interventions, and addressing patient social needs. One such partner is Philips, the creators of the Pregnancy+ mobile application (app). App users who are Michigan-based and report receiving Medicaid or not having insurance coverage are able to access Michigan-specific articles and connections to Michigan services through the app. Additionally, Michigan users gain free access to premium Pregnancy+ content, including videos on topics such as exercise and mental health.
The Pregnancy+ app is the most downloaded pregnancy app in the world, with one-third of Michigan pregnant women using it. As the first strategy for this objective, MDHHS will utilize the Pregnancy+ app to increase awareness of the importance of postpartum visits among its users. Philips has tailored the app with Michigan-specific articles and connections to Michigan-based resources. This includes an article explaining the importance of attending a postpartum visit and what to expect at this visit. The MDHHS team has also worked with Philips to develop a survey to assess the understanding and perspective of Michigan users related to postpartum visits. MDHHS will monitor the number of people viewing the postpartum visit article, the number who click through the links embedded in the article, and responses to the survey. It is expected that as more people utilize the app, pregnant women will acknowledge the importance of the postpartum visit and that the percentage of those attending a postpartum visit will increase.
Additional support for the ‘foster collaboration to strengthen coordinated systems’ pillar is the second strategy for this objective. This strategy fosters a partnership with Michigan State University (MSU) to support implementation of a postpartum module that will be included in the High Touch, High Tech (HT2) Pregnancy Checkup application (app). As of early 2025, 21 sites across five Regional Perinatal Quality Collaboratives have implemented universal electronic screening for mental and behavioral health. These clinical sites provide obstetric and/or preconception care and currently offer the screening tool to all new OB intake patients utilizing the Pregnancy Checkup app. Mental and behavioral health concerns continue after a pregnant woman gives birth; in fact, some mental and behavioral health concerns can become exacerbated in the postpartum period. In Michigan, between 2017 and 2021, most pregnancy-related deaths occurred both 1-42 days postpartum (38.6%) and 43 days or more postpartum (38.6%)[4]. In those same years, 16.7% of pregnancy-related deaths were due to substance use disorder and 6.8% were due to mental health conditions4. In addition to prenatal screening, MSU has created a postpartum module that includes evidence-based screening tools for mental and behavioral health, brief interventions specific to common postpartum mental and behavioral health concerns, and educational modules with related content. The postpartum module will be implemented at sites already utilizing the Pregnancy Checkup app, as well as any new prenatal and postpartum care sites interested in implementing the intervention.
The third strategy for this objective supports the pillars ‘foster collaboration to strengthen coordinated systems’ and ‘engage and elevate family and community voices. Elevating the stories of mothers and families; bringing awareness of the urgent maternal warning signs to providers, mothers and their support people; and informing mothers and their families of services and resources available, will raise awareness of the importance of postpartum visits. MDHHS will collaborate with internal and external partners across Michigan, and especially those serving individuals disproportionately affected by pregnancy related morbidity and mortality, to promote materials and resources related to the urgent maternal warning signs. These warning signs are key indicators of severe health issues that can occur in pregnancy or during the postpartum period. Promoting accompanying materials related to patient advocacy and empowerment, as well as educating providers on key questions to ask patients during medical visits, will give patients and providers the tools to address symptoms of severe health events which align with some of the leading causes of maternal morbidity and mortality in Michigan. It is anticipated that promotion and education of these materials and resources will increase the awareness of not only the warning signs, but also the importance of postpartum visits and having patient concerns heard and acknowledged by providers.
Home visiting services provide support to new parents across numerous areas. This support includes, but is not limited to, working with families to overcome barriers to care and well-being; providing education and support for infant feeding, care, and development; discussing the purpose and importance of a postpartum care visit; and ensuring parents and families are connected to resources that address their physical, social, and emotional needs. The support home visitors provide to encourage attendance at a postpartum visit is the fourth strategy for this objective. Through discussions with parents, home visitors can assist in identifying and addressing barriers in attending a postpartum visit, provide information on the purpose and importance of receiving postpartum care, and support access to postpartum visits. In 2023, 79.3% of women who enrolled in home visiting prenatally, or within 30 days postpartum, reported attending a postpartum visit with a healthcare provider within two months of giving birth[5]. The support that home visiting provides to encourage attendance of women at postpartum visits suggests that as enrollment and retention in home visiting services are maintained or increase, the likelihood that women will attend a postpartum care visit will also increase.
Perinatal Care (FY 2026 Application)
Strides have been made in advancing the health and well-being of mothers during the peripartum period. While existing efforts and initiatives have resulted in significant accomplishments in maternal health, persistent challenges remain, resulting in preventable maternal morbidity and mortality. Despite strength and resilience, Michigan families continue to face challenges that are closely associated with poor health outcomes. The Title V needs assessment also identified an overarching need for respectful, trauma-informed perinatal care for all. Addressing this National Performance Measure (NPM) that focuses on perinatal care aligns with the state priority need to ‘Improve the quality and accessibility of respectful care before, during, and after pregnancy.’
To work toward a healthcare system that treats all patients respectfully and improves health outcomes for all, Michigan plans to increase the number of doulas on the MDHHS Doula Registry, to increase access to doula care, implement quality improvement initiatives across clinical and community settings, and work with MI AIM to increase birthing hospital participation in the Joint Commission’s Maternal Level of Care Verification. These evidence-based strategies will ensure that all women receive quality and accessible respectful care before, during, and after pregnancy.
Objective A: By September 2030, increase the number of doulas on the Michigan Doula Registry by 1,000 doulas.
Michigan Medicaid Policy MMP 22-47 established criteria for the coverage of doula services in 2023. As a result of the policy, the MDHHS Doula Initiative was created to support doula providers, establish a doula advisory council, provide continuing education opportunities and to review doula certification programs.
Through community feedback sessions in the Title V needs assessment, a recurring theme emerged around patient rights and education on self-advocacy —issues that can be effectively addressed through doula care and support. Doulas promote person-centered, whole-family, trauma-informed care that focuses on the well-being of both the mother and family, themes that were also found in the needs assessment. Notably, community members and parents who participated in the Maternal Infant Health listening sessions identified the expansion of access to and promotion of doula services as a considerable strength in Michigan. According to the MCH Evidence, “Birth doulas provide physical, emotional, and informational assistance during the perinatal period, which has been reported to decrease maternal stress, lower rates of cesarean sections, and increase satisfaction with the birth experience.” Objective A reflects the Evidence-based Strategy Measure (ESM) for this NPM which is “By September 2030, increase the number of doulas on the Michigan Doula Registry by 1,000 doulas.” As of March 3, 2025, 689 doulas are on the registry. Therefore, the goal is to reach 1,689 doulas on the registry by September 2030.
In an effort to expand the doula network in Michigan and address the need for public health workforce expansion, a theme in the Title V Needs Assessment Partnership and Program Capacity (PPC) Assessment, the MDHHS Doula Initiative will continue to coordinate with various training organizations (listed on the MDHHS-Approved Doula Training Programs/Organizations) to provide one or more doula trainings across Michigan. To better provide care to all families, these trainings will prioritize an expansive cohort of doula training organizations. Trainings will continue to be of no cost, and participants will be eligible for a stipend upon completion of post training requirements that include four hours of recorded training, approval for listing on the Doula Registry, and Medicaid provider enrollment.
The Michigan Doula Advisory Council works to inform the advancement of doula services in Michigan. The council membership represents, to the extent possible, the various communities and settings in which doula services are provided. Membership includes statewide representation of doulas with a wide array of skillsets and backgrounds, including doulas who practice in rural and urban areas. This network of leaders supports doulas in their communities and across Michigan, acting as a conduit for the MDHHS Doula Initiative’s understanding of the doula provider experience. Specifically, the council will continue to be integral to the development of continuing education, doula gatherings, media campaign and other materials, and statewide strategic planning efforts.
The Doula Advisory Council along with the Doula Initiative will continue to work to foster collaboration, build trust and elevate the voices of individuals in program planning and development, outreach and awareness. These activities align with the Title V pillars to ‘foster collaboration to strengthen coordinated systems’ and ‘‘engage and elevate family and community voices.’ To promote doula services statewide, MDHHS Doula Initiative is working on a multi-media campaign focused on building awareness of doula care. The media campaign will direct families and partners to the Doula Initiative website which houses the Doula Registry. In addition, the Doula Initiative team will continue to offer presentations for internal and external partners on a regular basis; many of these strengthen referral networks, build trust and foster collaboration.
Objective B: By September 2030, implement quality improvement initiatives in partnership with Michigan’s nine Regional Perinatal Quality Collaboratives.
Michigan is dedicated to improving outcomes for families during the preconception, pregnancy, birth and postpartum periods which aligns with the Title V pillar to ‘advance strategies so all children and families can flourish.’ To support these efforts, the Michigan Department of Health and Human Services launched the Michigan Perinatal Quality Collaborative (MI PQC) in 2015. This model has been supported nationally by the Centers for Disease Control and Prevention since 2011. Currently, almost every state has a PQC or one in development.
Michigan boasts geographic and demographic uniqueness. To best address the uniqueness of each region, the MI PQC is divided into nine Regional Perinatal Quality Collaboratives (RPQCs). Each Collaborative authentically engages families and community members, convenes regular meetings with a variety of cross-sector partners, conducts systems change work and implements or supports evidence-based initiatives focused on advancing perinatal outcomes for pregnant women, babies, and families. Title V funding has directly supported the RPQCs and/or corresponding MCH initiatives.
To implement continuous quality improvement initiatives in partnership with the Michigan Perinatal Quality Collaboratives, new and existing members of RPQCs need a better understanding of quality improvement methodologies. By promoting and providing additional opportunities to learn the science and methodology of quality improvement, RPQC members and leadership will be better equipped to fully participate in creating and implementing quality improvement interventions.
Building on years of foundational work with RPQCs and their partners, each RPQC will implement at least one quality improvement intervention. RPQCs use state and local data to design data-driven, evidence-based interventions tailored to address specific community needs. By fostering relationships with families and communities, the RPQCs ensure that interventions are aligned with the unique requirements of their regions. RPQCs engage families by hosting local community baby showers, focus groups and listening sessions to uplift family voices and gain deeper insights into the needs of families. Many regions also involve family members on workgroups and leadership teams, strengthening the relevance and impact of their initiatives.
Michigan will collaborate with RPQCs to highlight their quality improvement initiatives and to increase community engagement and partnerships. Dissemination of strategies utilized by RPQCs has anecdotally shown that high quality initiatives will often be adopted by other regions and disseminated statewide. Helping RPQCs share knowledge and experiences minimizes the time it takes to adopt new ideas by providing a blueprint of potential successes, challenges, and strategies to implement an initiative. This also provides a way to develop and maintain partnerships across regions when multiple RPQCs collaborate on similar projects. Michigan ensures that members of the collaboratives and statewide partners are provided with statewide and regional data via a yearly data meeting. RPQCs are highlighted in quarterly maternal infant health collaborative meetings and at bi-yearly Town Halls. In addition, collaboratives have an opportunity to attend the annual Maternal Infant Health Summit to learn more about quality improvement initiatives occurring across the state.
Objective C: By September 2030, increase the number of birthing hospitals participating in MI AIM by 4% (Baseline 67) and enrolled in the Joint Commission Maternal Levels of Care Verification program by 18% (Baseline 53).
Michigan is collaborating with birthing hospitals to increase participation in the Michigan Alliance for Innovation on Maternal Health (MI AIM) and the Joint Commission’s Maternal Levels of Care (MLC) Verification Program. Michigan was the first of seven states to bring the National AIM program to the state’s hospitals and birthing mothers in 2016. The Michigan Alliance for Innovation on Maternal Health (MI AIM) is dedicated to improving maternal safety by decreasing preventable severe maternal morbidity and mortality through the implementation of early recognition patient safety bundles. Similarly, Maternal Levels of Care Verification facilitates more safe, successful births and maternal outcomes for all mothers. With verification, a facility can strengthen the community’s confidence in the quality and safety of its services and treatments. While both initiatives are inherently working to advance maternal and infant health, Michigan is also working to further disseminate the health care quality performance data publicly.
By September 2030, Michigan will increase the number of birthing hospitals participating in MI AIM by 4 percent, or 3 hospitals, thus improving MI AIM participation from 67 to 70 birthing hospitals. Supporting widespread implementation of the MI AIM patient safety bundles—all of which include elements focused on the provision of respectful and supportive care—addresses some of the dominant themes found in the Title V needs assessment.
Michigan will increase the number of hospitals enrolled in the Joint Commission Maternal Levels of Care (MLC) Verification program by 18 percent, or 10 hospitals, thus increasing participation from 53 to 63 birthing hospitals. To ensure birthing hospitals can complete materials on The Joint Commission’s Maternal Level of Care (MLC) Verification, a partnership with MI AIM will pair Maternal Levels of Care Verification birthing hospitals with birthing hospitals seeking to apply, building a mentor/mentee relationship. Fostering and building up these partnerships between MI AIM, MLC, MDHHS and birthing hospitals will help strengthen collaboration and build trust within these systems. Training and capacity building with birthing hospitals will be available through weekly virtual office hours or one-on-one meetings with individual hospitals. Michigan will collaborate with birthing hospitals to help eliminate barriers to applying for Maternal Levels of Care Verification through in-person meetings with hospitals to discuss challenges and provide resources. In addition, in 2024 Michigan provided state dollars to cover the cost of application and the Joint Commission site visit for MLC applicants and provided payment to support quality improvement initiatives focused on improving maternal outcomes. Michigan plans to continue this funding.
To promote MI AIM and MLC participation and information dissemination, Michigan will partner with the RPQCs to host MI AIM representatives at RPQC meetings. This will start to bridge the clinical-community gap and provide an avenue for information dissemination. In addition to this initial step, Michigan plans to establish a website or dashboard for review by the public highlighting performance metrics and quality improvement initiatives that birthing hospitals participate in, such as MI AIM and MLC. A multi-media campaign will be created to uplift the multidisciplinary work of the RPQCs and birthing hospitals and to help inform the public about these initiatives, while also working toward optimal birth outcomes for all mothers and infants. Michigan already hosts many community engagement opportunities and will use these town halls, quarterly meetings, the Maternal Infant Health Summit and more to build trust and promote transparency with families, communities and valued partners.
Oral Health – Women (FY 2026 Application)
The Title V needs assessment identified need among Michigan’s MCH population related to gaps in dental services for certain populations including young children and pregnant women. Focus group respondents identified a need for more standardized care practices for dental professionals to offer treatment options to people with access to care barriers as well as an overall shortage of dental providers that will accept Medicaid. As a result, a state priority need was established to “expand awareness of and access to quality dental care for children and pregnant women.” Title V funding provides partial support of an Oral Health Epidemiologist who is responsible for analyzing oral health statistics, oral health utilization of pregnant women and adults, and Medicaid dental claims.
Leadership for Michigan’s MCH oral health programs and initiatives is located within the Oral Health Section. The Oral Health Section and Perinatal Oral Health Initiative are housed in the Child and Adolescent Health Division within the Bureau of Health and Wellness in the Population Health Administration, allowing for significant collaboration, particularly on issues related to women’s oral health. The Perinatal Oral Health Initiative partners with state programs such as the Maternal Infant Health Program and WIC and also with Michigan medical and dental schools, nurse practitioner programs, community organizations, refugee entities, and local health departments. These partnerships focus on serving populations with the highest level of need. The Perinatal Oral Health Initiative also continues to partner with Medicaid in the enhanced dental benefit for pregnant women, which includes coverage for services up to one year postpartum. The enhanced adult dental Medicaid benefit continues to be implemented, and promotion and outreach around these benefits will play a key role in programmatic activities for FY 2026.
In FY 2026, the Perinatal Oral Health Initiative will continue to maintain educational efforts for the health community and expecting mothers while also continuing to explore additional data to help implement new programs that further address oral health access to care issues. Current Medicaid data indicate that gaps exist and the longstanding problem of low participation in Medicaid among dentists continues.
From October 2023 through March 2024, only 1 in 5 pregnant women on Medicaid in Michigan received any dental care during their pregnancy. Less than 7% of pregnant women statewide had any restorative care. African American and Latino pregnant women continue to be less likely to have a dental visit than White pregnant women. Existing strategies that educate providers as well as new strategies that focus on alternative practice models, along with Medicaid enhancements, will be harnessed to address gaps. Mapping from the University of Michigan that shows access to care gaps by prosperity region will be shared with stakeholders in local communities and utilized for targeted interventions. The data will also continue to be used to bring awareness to the state of Medicaid utilization in Michigan, workforce shortages, and how to create a path forward to address the oral health needs of pregnant women in Michigan. A new approach in 2026 will be the addition of an oral health focused Health Educator in the OBGYN department within the Detroit Medical Center (DMC) that will include a comprehensive education initiative for providers and patients.
Objective A: Increase the number of medical and dental providers trained to treat, screen, and refer pregnant women and infants to oral health services.
In FY 2026, the MDHHS Oral Health Program (OHP) will continue to expand efforts to train and educate the medical and dental communities on the importance of perinatal oral health, as well as methodologies and best practices to integrate perinatal oral health into practice. The program includes a virtual modality and has systems in place to accommodate virtual trainings but also completes in-person trainings as needed. While providers who discussed or encouraged dental care during pregnancy were mentioned as strengths by some state led focus group participants, most participants expressed a lack of prioritization of preventive dental health on the part of healthcare providers. The need for medical/dental integration was further acknowledged from participants, with feedback that OBGYNs and providers were not stressing dental care during prenatal care; there was a lack of education for patients on the impact of pregnancy and breastfeeding on dental health; and that dental professionals were postponing complex treatments for pregnant women due to safety concerns.
On the provider end, data collected from a statewide provider survey indicates that many medical providers (82%) acknowledged that perinatal oral health was an important consideration for optimal obstetric management; however, only one-fifth (22%) of providers stated that they routinely examined the patients’ oral cavity during pregnancy. PRAMS and Medicaid data indicated that continued education efforts must also occur in the dental community surrounding pregnancy, as utilization rates remain low among pregnant women. Data driven efforts will continue to focus on access gaps in specific Michigan regions. In FY 2022, OHP began educational efforts at a new public health program (Central Michigan University) with a commitment to continue these perinatal oral health lectures. FY 2026 will see a concerted effort with private practice dentists and Dental Associations to further target these providers, utilizing the Medicaid dental benefit tool to engage the dental community. Additionally, the OHP is launching a health educator pilot program for targeted oral health education in OBGYN settings in the Detroit region. If duplicated, this pilot has the potential to increase services to populations in the state.
The Evidence-based or -informed Strategy Measure (ESM), which is the number of medical and dental professionals who receive perinatal oral health education through MDHHS within a 12-month period, is part of this objective. Research shows that obstetric and dental providers can help pregnant women start and/or maintain oral health care (Oral Health Care During Pregnancy and Through the Lifespan | ACOG). Departmental trainings and workshops will increase provider knowledge of perinatal oral health as well as provider comfort in discussing the importance of oral health with patients. Trainings will address a variety of oral health access issues. A database of training records continues to be utilized, with the output defined as the number of medical and dental professionals trained by MDHHS. The Perinatal Oral Health Initiative will continue to encourage provider feedback and engagement regarding these trainings with the intention to continue hybrid trainings as applicable.
Another strategy is dissemination of perinatal promotional and educational materials. Together with a variety of medical and dental professionals and other stakeholders, MDHHS will update the Perinatal Oral Health Guidelines to create a unifying voice that emphasizes the importance of perinatal oral health to perinatal care and dental providers. The guidelines will provide state-specific resources and tools; provide a summary of the issues surrounding perinatal oral health; and promote the consistent delivery of medical and dental services. Other materials will focus on best practices, specific access gaps by region, and proposed recommendations to address access to care issues with providers. MDHHS will continue to utilize nationally recognized American Academy of Pediatrics (AAP) materials that are co-branded with both agency logos. MDHHS will continue to develop and distribute promotional and education materials that promote dental visits during pregnancy and infant oral health to health entities across the state and directly to pregnant women. These materials will continue to be developed in partnership with community stakeholders and distributed to local health departments, Federally Qualified Health Centers (FQHCs), WIC clinics, dental offices, the Office of Great Start, home visiting, medical offices (including obstetric providers) and other entities to increase awareness of tools, webinars, and best practices to help agencies engage families in a meaningful and sustained manner. Material promotion has been a successful strategy and will continue in FY 2026. Efforts will focus on virtual methods of dissemination where applicable.
The education strategy will include the continuation of communication efforts for dental health providers surrounding changes in Medicaid benefits for pregnant women as well as the entire adult Medicaid benefit. MDHHS allotted funds to increase the adult dental Medicaid benefit for pregnant women in FY 2022, and in FY 2023 increased reimbursement and allowable services. This increase in benefits is addressing a critical need in access to care and increasing the number of pregnant women with a dental visit. The number of pregnant women on Medicaid who have at least one dental encounter during the perinatal period is a second ESM. Through a data use agreement and IRB with Child Health Evaluation and Research (CHEAR) Center at the University of Michigan, the oral health program will be able to obtain data. CHEAR has access to the data warehouse and the technical ability to analyze the data. Medicaid utilization data that became available in FY 2022 will be crucial to continue to measure the impact of the benefit and guide further educational efforts in FY 2026. This strategy aligns with other statewide efforts by focusing on data-driven solutions, addressing the need for comprehensive care, and reducing poor health outcomes.
Objective B: Increase the number of pregnant women receiving oral health education and services.
In FY 2026, the OHP will continue to analyze PRAMS data and new Medicaid data to assess healthcare access gaps. Data will be examined by geographic area which will help to determine targeted interventions, and a new data dashboard will be updated to reflect perinatal oral health trends geographically. Targeted interventions will be considered according to the population and groups they address. Efforts will be made to integrate community voice, a Title V pillar, as data efforts move forward and focus on engaging with communities across the state through local oral health coalitions. These coalitions are composed of local professionals and community members representing the populations that are being served.
In FY 2026, the OHP will continue to take the lessons learned from previous medical dental integrations efforts such as the Michigan Initiative for Maternal Infant Oral Health and will look to promote the best practices discovered surrounding efforts to integrate medical and dental professionals. The OHP will also continue to provide education to pregnant women and engage directly with local communities via partnerships with different agencies and groups. This will include the advancement of education, training and outreach efforts with community health workers and doulas whose services are reimbursed by Medicaid, but also with other community organizations, state agencies (local health departments), nonprofits and families. As reflected in the needs assessment, there is a need to deepen family and community engagement and ensure that initiatives actively recruit and authentically engage families as collaborators in advisory boards, strategic planning, education and evaluation activities. By fostering collaboration and alignment among stakeholders, these partnerships create opportunities to address complex needs in an integrated manner and strengthen coordinated systems, a Title V pillar. Focus group participants described numerous contextual factors within their communities that impact maternal infant health, including perinatal oral health. Inability to meet basic needs can have a direct impact on maternal oral health care access. Providers surveyed acknowledged the need to improve transportation, childcare and other supports to help patients attend appointments.
In 2026, the OHP will focus on community engagement by continuing to work with partners such as Sister Friends. Sister Friends Detroit is a volunteer effort to support healthier maternal outcomes and access to services and resources in Detroit. It aims to improve birth outcomes and infant mortality rates by connecting mentors to women who are pregnant. The OHP started holding oral health educational sessions in FY 2022 with the intention to continue into 2026. Feedback from pregnant women and their mentors has been extremely positive and this practical presentation helps to not only answer common questions and address concerns but also provides an opportunity to hear directly from pregnant women and engage authentically with Michiganders. For example, feedback has helped shape the presentation and add more relevant content.
In FY 2026, the OHP will continue its collaboration with the Office of Great Start within the Michigan Department of Lifelong Education, Advancement, and Potential (MiLEAP) to share relevant information with different parent and community advisor groups, along with the Wayne County Oral Health Coalition and Michigan Association of Community Health Workers. The OHP will also actively seek new partnerships. Working to bring partners together to address oral health needs in an accessible setting will be a priority for the OHP in 2026. A Perinatal Oral Health Resource Day(s) will be held at University of Detroit School of Dentistry. Attendees will receive information and support for a variety of basic needs though community groups, nonprofits and government entities along with making appointments in the dental school for preventative and restorative care. OHP will also provide education to dental students, residents and patients. These collaborations allow the OHP to receive even more community feedback and develop connections and partnerships that help pregnant women receive the care they need.
Contraceptive Use (FY 2026 Application)
The Michigan Department of Health and Human Services (MDHHS), in partnership with the Michigan Public Health Institute (MPHI), conducted a Title V needs assessment to evaluate maternal and child health services across the state. As part of this effort, contraceptive use emerged as a key focus area, highlighting both strengths and challenges in reproductive health access. Through a series of listening sessions, focus groups, surveys, and data analyses, key themes and insights emerged as barriers individuals face in accessing contraceptive care, as well as opportunities for improvement.
Some of the most pressing findings of the assessment are the need to increase awareness of contractive options, enhanced access to affordable and inclusive reproductive care, and provision of youth specific sexual and reproductive health care. Many individuals, particularly young people, reported that they lacked sufficient information about their contraceptive options. At the same time, young people voiced concerns about the lack of accessible reproductive health services, highlighting barriers such as affordability, stigma, and provider availability. Many respondents emphasized the importance of improving community engagement and education to ensure that individuals can make informed choices about their reproductive health. Despite these challenges, the assessment also revealed important opportunities to strengthen Michigan’s reproductive health landscape. Sexual and Reproductive Health (SRH) is a key focus in pre-pregnancy care, providing a foundation to expand conversations about contraception in a more balanced and patient-centered way. Michigan’s existing family planning programs have been instrumental in expanding reproductive health education and services, creating an opportunity to build upon these efforts.
In response to these findings, MDHHS has identified relevant strategies to address the barriers identified in the Title V needs assessment and capitalize on opportunities for improvement. Strategies are focused on expanding free and low-cost contraceptive services to improve accessibility for uninsured, underinsured, teen and male clients; monitoring and improving satisfaction of services by clients to ensure they receive clear information about their contraceptive options; and increasing and expanding outreach and promotion of SRH services to ensure that Michiganders have access to the reproductive health care they need. Addressing these challenges and implementing targeted strategies will move toward improved sexual and reproductive health services that are accessible, informed, and patient centered.
Title V funding plays a critical role in supplementing Title X Family Planning Program funding and state funds to ensure access to reproductive health care and service delivery in Michigan. Title V funding helps to support contraceptive access through local agencies with a focus on serving individuals 15 through 21 years of age at no or low cost through a network of 33 agencies encompassing 90 clinics throughout Michigan. Michigan’s Contraceptive Use State Performance Measure (SPM) is the percent of most or moderately effective contraception use among women 18-49 who reported doing something to prevent pregnancy during last intercourse. Based on the most recent data, 65.1% of women 18-49 report using a most or moderately effective contraceptive method during the last time they had sexual intercourse (Michigan Behavioral Risk Factor Surveillance System, 2022). Understanding contraceptive use is crucial for gauging reproductive health and fertility patterns, particularly among women aged 18-49. Utilizing data from the Michigan Behavioral Risk Factor Surveillance System (MiBRFSS), the contraceptive use measure tracks effective contraceptive use to identify gaps and inform public health strategies.
Objective A: By 2030, maintain the number of Family Planning Clients who rate their experience of care as a score of 4 or 5 out of 5 on the Consumer Surveys Person-Centered Contraceptive Care (PCCC) measure at 95% or higher.
A key aspect for Michigan’s Family Planning Program to be responsive to the needs and experiences of the communities served is to ensure services are trauma-informed, patient-centered, and that providers have the tools they need to deliver person-centered contraceptive care. MDHHS has identified several strategies to improve these skills among family planning staff and providers, starting with a baseline understanding of client perceptions of these services through the administration of the Michigan Family Planning Consumer Survey.
To achieve the objective of maintaining the number of Family Planning clients who rate their experience of care as a score of 4 or 5 out of 5 on the Consumer Surveys (TACS) Person-Centered Contraceptive Care (PCCC) measure at 95% or higher, MDHHS will focus on continuing to ensure a high quality of care and client experience. This objective supports the Title V pillar to advance strategies so all children and families can flourish by ensuring that services are responsive to the needs and experiences of the communities they serve. This work is informed by the Title V needs assessment, which highlighted the importance of amplifying client voices and improving the quality of reproductive health services.
In FY 2026, MDHHS will focus on ensuring sexual and reproductive health services are provided in a respectful manner. MDHHS relies on the PCCC measure to assess client satisfaction with services received annually. The PCCC measure explores the quality of contraceptive care clients receive from their provider, such as whether they feel they are being treated with dignity and respect, are provided adequate information, and are in a judgment-free environment. Through ongoing consultation with local agencies, MDHHS will work to identify and reinforce best practices that contribute to favorable PCCC scores, ensuring the ensuring the provision of quality care and support of local agency continuous quality improvement efforts.
As a second strategy, MDHHS will focus on ensuring sexual and reproductive health services are trauma informed. Family Planning local agencies will address trauma-informed care (TIC) in their program plans by assessing the degree to which their services are trauma-informed and developing an objective to improve those services. The TIC strategies in program plans will be reviewed annually, and feedback provided to agencies, along with monitoring of TIC activities and discussion during regularly scheduled site visits. This strategy supports person-centered family-building, a core component of Pillar 1. By integrating TIC principles into service delivery planning, agencies can better address the needs of individuals who have experienced trauma, which is often a significant barrier to accessing and utilizing reproductive health services.
MDHHS will continue to promote its contraceptive counseling modules as a third strategy, which includes Person-Centered Contraceptive Counseling tools. These modules will be promoted within the Family Planning network, as well as to other providers and partners to equip those providing SRH services with the necessary skills to deliver patient-centered, resonant and respectful services. By sharing the Contraceptive Counseling Modules widely, MDHHS will reach a broad audience of healthcare providers and public health professionals to encourage the utilization of contraceptive counseling best practices. These best practices assist clients with identifying a method that best fits their needs and preferences, free from coercion, as contraceptive methods that meet client preferences are more likely to be used correctly and consistently. MDHHS will utilize program and partner communication mechanisms (e.g., newsletters, listservs) to promote the Contraceptive Counseling Modules. Offering 1.25 nursing contact hours will incentivize participation and MDHHS will monitor module completion rates and participant satisfaction on a quarterly basis. This will allow agencies and providers to meet population-specific needs and ensure that services are delivered in a way that respects individual autonomy and preferences, as highlighted in the Title V needs assessment findings on the importance of client-centered care.
The analysis and sharing of Teen and Adult Consumer Survey data with the family planning network will provide valuable insights into the effectiveness of reproductive health strategies and service delivery. This strategy aligns with Pillar 1's emphasis on centering data that reflects the experiences and voices of communities facing sub-optimal health outcomes. By analyzing TACS data, MDHHS family planning can identify areas for improvement and tailor strategies to meet the specific needs of priority populations. This data-driven approach, as supported by the Title V needs assessment, will ensure that services are responsive to the evolving needs of the community and that resources are allocated effectively.
Objective B: By 2030, expand access to Sexual and Reproductive Health (SRH) services by increasing the number of unduplicated clients served by 5% from 2024 baseline.
A finding from the Title V needs assessment was the need to expand the provision of free and low-cost contraceptives and family planning services, to ensure those most in need have access to the necessary services to make important decisions about their sexual and reproductive health. To achieve the objective of expanding access to SRH services by 5% in Michigan’s Family Planning Program by 2030, a multi-faceted approach is essential. The approach centers on strengthening coordinated systems, addressing identified community needs, and bolstering program capacity through strategic partnerships.
First, the strategy of providing training and education on Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Population Affairs, 2024 (QFP) directly addresses the need to build enhanced systems of care by expanding the scope of services to include clients receiving STI services. This expansion, coupled with network technical assistance (TA) will broaden access to comprehensive SRH services. By expanding the definition of “encounter”, the initiative builds awareness of available programs and services, ensuring that individuals understand the full range of support offered within the family planning program. This strategy also directly supports guidance on streamlining eligibility and enrollment requirements and procedures by broadening the services that qualify under the QFP. In 2026, a focus will be placed on ensuring Michigan’s Family Planning network of 33 local agencies and 90 clinical sites offer contraceptive services in accordance with the 2024 QFP guidelines, with a requirement to have a broad range of contraceptives available. This will be monitored through semi-annual Family Planning Annual Report (FPAR) submissions, ensuring consistent implementation and accountability. This directly addresses the Title V Needs Assessment Partnership and Program Capacity Survey’s call to increase awareness of tools, webinars, and best practices, as well as the need to embed family engagement requirements into funding structures. By working closely with Michigan’s family planning network, these activities also align with the Title V pillar to foster collaboration to strengthen coordinated systems.
The second strategy is supporting local agencies in the provision of a broad range of contraception including Long-Acting Reversible Contraception (LARC) and condoms. This strategy addresses the Title V Need Assessment recommendation of identifying barriers for improving accessibility and affordability of family planning methods. Stocking all Federal Drug Administration (FDA) approved methods, including LARC, is necessary to ensure full access to care. In FY 2026, the Michigan Family Planning Program will offer at least one clinical practicum to enhance provider knowledge and competency in LARC insertions. Additionally, the 2026 Annual Family Planning Conference will feature a dedicated session on contraceptive methods, further supporting provider education and expanding awareness of available options. Access to a broad range of contraception at local agencies will be monitored through monitoring visits and site reviews. Provision of condoms is particularly crucial for individuals who may lack consistent access or lack trust in traditional healthcare systems. By making condoms available for free, providers build awareness of accessible family planning options. This strategy helps to build trust with communities.
Third, to maintain the number of males served in family planning clinics at 15% of the total population served, MDHHS will leverage the resources and training opportunities provided by the Reproductive Health National Training Center (RHNTC) and the Clinical Training Center for Sexual and Reproductive Health (CTC-SRH). These resources are designed to enhance male engagement and service provision within family planning clinics. Additionally, the proportion of males to overall population served will be monitored and discussed with local agencies during data quality review meetings. This strategy addresses the Title V pillar to strengthen family and community engagement by ensuring that initiatives actively recruit and engage men, a population that historically underutilizes SRH services. Moreover, this strategy aligns with the Title V Needs Assessment Partnership and Program Capacity Survey's emphasis on providing training for staff to strengthen engagement practices and reduce barriers to knowledge and outreach. By focusing on male engagement, providers address identified gaps in knowledge about healthcare services and programs and the need for contraceptive counseling. This strategy aligns the Title V pillar to foster collaboration and build inclusive systems by ensuring that all community members, including men, have access to comprehensive SRH services.
Objective C: By 2030, all Family Planning agencies will include a community education and promotion objective in their annual family planning work plans.
Effective community education and promotion are critical for ensuring access to and utilization of SRH services. To achieve this, family planning agencies will develop and integrate targeted outreach strategies into their annual work plans, focusing on utilizing best practices to address identified community needs. Through promotion of best practices for engagement in family planning services, identified strategies will be essential in further expanding access to SRH services by building awareness of available programs and services. This approach aims to build sustainable structures that elevate client and community voices.
The first strategy focuses on educating the family planning network on best practices regarding use of outreach and engagement strategies to reach adolescents directly. This strategy aligns with the Title V needs assessment finding regarding youths’ concerns about reproductive and sexual health. Teens face unique healthcare challenges due to significant physical, emotional, and social changes, as well as barriers such as stigma, confidentiality concerns, and limited access to trusted healthcare providers. Reaching teens with accurate, judgment-free information about contraception and sexual health is critical for reducing unintended pregnancies, promoting healthy decision-making, and fostering lifelong positive health behaviors. In FY 2026, the family planning program will disseminate best practices for adolescent outreach and engagement, and share resources designed to equip family planning programs with the information and tools they need to effectively engage this demographic. Best practices will incorporate evidence-based strategies, including peer education, social media campaigns, and examples of youth-friendly clinic environments. MDHHS will work with MOASH to share best practices for teen engagement acquired through listening sessions with their Youth Advisory Committee (YAC). By prioritizing youth engagement and improving accessibility to sexual and reproductive health services, this strategy aligns with the Title V pillar by elevating the voices of young people and building sustainable structures for meaningful engagement in their healthcare decisions.
The second strategy is to conduct an annual media campaign to raise public awareness about SRH services and resources and promote informed decision making. In FY 2026, a comprehensive media plan will be developed and implemented. This media plan will focus on leveraging social media outlets including radio streaming platforms to expand audience reach. Data from the Title V Needs Assessment Partnership and Program Capacity Survey highlights the need to increase awareness of tools and best practices to inform the development of educational materials and messaging.
One of the recommendations from the Title V Needs Assessment Partnership and Program Capacity survey is to deepen family and community engagement in services. By focusing efforts on scaling up community participation in local family planning advisory councils through the provision of technical assistance, MDHHS’ focus is to foster sustainable engagement structures and elevate the perspectives of those most impacted by SHR programs. In FY 2026, MDHHS family planning will provide targeted technical assistance to subrecipients on establishing and maintaining effective advisory councils. This assistance will include guidance on developing recruitment strategies, facilitating meetings, and ensuring that council members have meaningful input into program planning and evaluation. Training resources will be provided on best practices for engaging community members representative of the populations served, including parents, youth, and individuals. The advisory councils serve as a platform for elevating community voices and ensuring that programs are responsive to local needs. This strategy directly aligns the Title V pillar on community voice by building sustainable structures for engagement and elevating the voices individuals. By focusing on recruitment and sustainability of these councils, agencies will be able to more effectively respond to the needs outlined in the needs assessment.
[1] Optimizing Postpartum Care. ACOG Committee Opinion, May 2018. Vol. 131, NO. 5.
[2] Michigan Maternal Mortality Dashboard, 2017-2021.
[3] Michigan Pregnancy Assessment Monitoring System (PRAMS)
[4] Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics, Resident Death Files, 2016-2020.
[5] Michigan Home Visiting Legislative Report, 2023
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