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CMS Model to Push Care Access for Maternal Opioid Use Disorder

The Maternal Opioid Misuse model will help connect expectant or new mothers to better care access and care coordination.

opioid access to care

By Sara Heath

- CMS is launching a new Medicaid care model that will improve care coordination, behavioral health integration, and access to care for expectant and new mothers with opioid use disorder (OUD).

The Maternal Opioid Misuse (MOM) model aims to create a web of medical supports for expectant and new mothers to help them manage an OUD. Specifically, the care model, which can be implemented on a statewide level, aims to help patients overcome the barriers they experience when seeking opioid misuse treatment.

“Too many barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women struggling with opioid misuse, including lack of access to treatment and a shortage of providers in rural areas, where the opioid crisis is especially destructive,” said HHS Secretary Alex Azar in a statement. “The MOM model will support state Medicaid agencies, front-line providers and healthcare systems to help ensure that mothers and infants afflicted by the opioid epidemic get the care they need.”

Issues related to opioid misuse are currently the leading cause of death among new mothers, CMS reported. Exacerbating that problem is the number of challenges expectant mothers face in accessing treatment for opioid use disorder, including:

  • Lack of access to comprehensive services during pregnancy and the postpartum period, even though state Medicaid programs may be able to provide the necessary coverage through state plan amendments or waivers.
  • Fragmented systems of care, which miss a critical opportunity to effectively treat women with OUD at a time when they may be especially engaged with the healthcare system.
  • Shortage of maternity care and substance use treatment providers for pregnant and postpartum women with OUD covered by Medicaid, especially in rural areas, where the opioid crisis is magnified.

Pregnant or postpartum patients who have OUD tend to be high-risk for adverse outcomes of pregnancy and birth. Specifically, these patients are more likely to experience preterm labor and complications during delivery than patients who do not experience OUD.

Additionally, patients with OUD tend to see other social determinants of health, including poor nourishment or domestic or interpersonal violence.

OUD among expectant mothers also poses risks to the baby. Babies exposed to opioids before birth see an increased risk of being born premature, having a low birth weight, and experiencing the symptoms of neonatal abstinence syndrome (NAS). NAS is when the baby experiences withdrawal symptoms from the drugs it has been exposed to in the womb.

Fundamentally, the MOM model aims to improve care quality while lowering healthcare costs, CMS explained.

Additionally, the model aims to improve access to healthcare for expectant or new mothers, especially as it relates to service-delivery capacity. Mothers experiencing OUD in rural areas may struggle to access qualified providers, for example. CMS plans to funnel certain resources and infrastructure based on state needs.

Finally, the MOM model aims to expand health coverage to patient participants. Targeted payment models will facilitate care coordination and care integration.

The CMS Innovation Center will begin by creating 12 cooperative agreements with states that will carry out the model. Medicaid and CHIP beneficiaries with an opioid misuse disorder who opt into the program will see support during the prenatal, peripartum, and postpartum stages of pregnancy.

State program administrators must ensure patients have access to designated physical and behavioral health services, medication-assisted treatment (MAT), maternity care, primary care services, and other services beyond MAT.

The model will be implemented in five-year performance periods. There will be different opportunities for participants to receive funding, including during pre-implementation, transition, and full implementation.

CMS has allocated $64.6 million for the program across the 12 state participants.

Earlier this year, CMS introduced a care delivery model aimed at improving access to behavioral and mental health services for CHIP beneficiaries. The Integrate Care for Kids (InCK) model aims to improve care coordination and integration of behavioral and mental health for patients experiencing certain symptoms, including substance use.

The model will empower state Medicaid and CHIP agencies to work with community health workers to address healthcare needs. Additionally, the program will improve patient access to necessary treatments.


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