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CMS Model to Care for New, Expectant Moms with Opioid Use Disorder

October 24, 2018

Overcoming obstacles to coordinated, integrated care for pregnant women and new mothers with opioid use disorder (OUD) is the thrust of a new model developed by the CMS Innovation Center that will join “care-delivery partners” with state Medicaid agencies as part of a federal multi-faceted strategy to tackle the opioid epidemic.

The initiative, based on the Maternal Opioid Misuse (MOM) model, will create up to 12 cooperative agreements with states. A maximum of $64.6 million will be awarded over the five-year program’s duration. Medicaid agencies will implement the model with one or more community-based care-delivery partners to serve Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries during the prenatal, peripartum and postpartum periods.

The partners participating in the program will work to ensure that beneficiaries receive a set of essential health services, including medication-assisted treatment (MAT), primary care and appropriate behavioral health services.  Funding for the five-year program will be provided in three phases:  pre-implementation (year 1), transition (year 2) and full implementation (years 3-5).

Substance abuse-related illness, including OUD, is a leading cause of maternal death. Women with substance abuse problems during pregnancy are at high risk for poor maternal outcomes, including preterm labor and delivery complications.  Infants exposed to opioids before birth are at increased risk of low birth weight and neonatal abstinence syndrome (NAS). A variety of other factors, including malnourishment, interpersonal violence and other social and medical needs complicate the overall picture.

More specifically, the MOM model will seek to:

  • Improve the quality of care and reduce expenditures for pregnant and postpartum women with OUD and their infants
  • Increase access to treatment as well as service-delivery capacity and infrastructure, based on state-specific needs
  • Create sustainable coverage and payment strategies for coordinated, integrated care

“The MOM model will support state Medicaid agencies, front-line providers and healthcare systems to ensure that mothers and infants afflicted by the opioid epidemic get the care they need,” Health and Human Services Secretary Alex Azar said in a statement.  He noted the existing barriers to well-coordinated treatment for pregnant and postpartum women with OUD, including a shortage of providers in rural areas.

CMS plans to release a notice of funding opportunity in early 2019. State Medicaid agencies will be responsible for completing the application and must demonstrate a partnership with one or more care-delivery partners. 

More information on the MOM model and the funding opportunity is available here.

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