Maternal Opioid Misuse (MOM) Model

The Maternal Opioid Misuse (MOM) model is the next step in the Center for Medicare and Medicaid Innovation’s (Innovation Center) multi-pronged strategy to combat the nation’s opioid crisis. The model addresses fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the MOM model has the potential to improve quality of care and reduce costs for mothers and infants.

Background

The surge in substance use-related illness and death in recent years particularly affects pregnant women. In fact, substance use is now a leading cause of maternal death. Pregnant and postpartum women who misuse substances are at high risk for poor maternal outcomes, including preterm labor and complications related to delivery; problems frequently exacerbated by malnourishment, interpersonal violence, and other health-related social needs. Infants exposed to opioids before birth also face negative outcomes, with a higher risk of being born preterm, having a low birth weight, and experiencing the effects of neonatal abstinence syndrome (NAS). In addition, Medicaid pays the largest portion of hospital charges for maternal substance use, as well as a majority of the $1.5 billion annual cost of NAS. Despite the significant and costly burden of maternal opioid misuse, numerous barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women with OUD, 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.

Model Details

The primary goals of the MOM Model are to:

  • improve quality of care and reduce costs for pregnant and postpartum women with OUD as well as their infants;
  • expand access, service-delivery capacity, and infrastructure based on state-specific needs; and
  • create sustainable coverage and payment strategies that support ongoing coordination and integration of care.

These goals will be achieved through a variety of approaches, including:

  • Fostering coordinated and integrated care delivery: Support the delivery of coordinated and integrated physical health care, behavioral health care, and critical wrap-around services.
  • Utilizing Innovation Center authorities and state flexibility: Leverage the use of existing Medicaid flexibility to pay for sustainable care for the model population.
  • Strengthening capacity and infrastructure: Invest in institutional and organizational capacity to address key challenges in the provision of coordinated and integrated care.

Funding

The CMS Center for Medicare and Medicaid Innovation (Innovation Center) will execute up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery partners” in their communities.

CMS anticipates releasing a Notice of Funding Opportunity (NOFO) in early 2019 to solicit cooperative agreement applications to implement the MOM model. The state Medicaid agency and care-delivery partner(s) will be expected to complete the application together. A maximum of $64.5 million will be available for state awardees over the course of the five-year model. The NOFO will contain all program requirements and eligibility criteria for potential applicants.

In August, CMS announced the Integrated Care for Kids (InCK) Model, a child-centered local service delivery and state payment model aimed at reducing expenditures and improving the quality of care for children covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of priority health concerns like behavioral health challenges, including substance misuse. CMS will release a NOFO for the InCK Model at the same time as it does for the MOM Model.

Timeline

The MOM model will have a five-year period of performance with different types of funding. The implementation funding, transition funding, and opportunity for milestone funding will be provided in three distinct model periods: Pre-implementation (Year 1), Transition (Year 2), and Full Implementation (Years 3-5).

Care delivery will begin in Year 2 of the model, the Transition Period. During this year, funding for care-delivery services that are not otherwise covered by Medicaid will be provided by Innovation Center funds. By Year 3, the start of the Full Implementation Period, states must implement their coverage and payment strategies. This overall structure seeks to balance rapid model initiation and state flexibility, while minimizing administrative burden. In particular, the MOM model design supports each awardee’s ability to quickly begin delivering coordinated and integrated care to pregnant and postpartum women with OUD during the Transition Period, while supporting states in developing a long-term coverage and payment strategy that aligns with their state Medicaid program.

If you are interested in additional information about the Maternal Opioid Misuse (MOM) Model, please contact MOMmodel@cms.hhs.gov.

Additional Information