A Window into Biden-Harris Administration Actions to Support Maternal Health and Recommendations for Future Actions 

Authors: Silicia Lomax, Anna Britt, Gina Drioane, Caitlin Krutsick, Zara Day 

Waxman Strategies wishes the happiest of Mother’s Days to all the incredible mothers, by blood and by love, who truly make the world spin. While we promise that we are giving flowers to the mothers in our own personal circles, we also want to take this moment to honor mothers across the country by advocating for their wellness, health, and lives.  

We want to start by noting that Waxman Strategies has a deep commitment to ensuring all people have meaningful access to the full spectrum of reproductive health care, including contraceptives, abortion, and prenatal and postpartum care. Our work is centered in diversity, equity, inclusion, and justice for all people, and we use this lens to work towards a healthier, more equitable future for all. So, while the ability to avoid or end a pregnancy has been centered in the national dialogue and in much of our own work in recent months, we know it is critical that conversations about reproductive health also address the ability to safely carry out a pregnancy. That is the conversation we’d like to contribute to today — in short: this one is for moms. 

The Maternal Health Crisis

Tragically, the U.S. has seen maternal mortality and morbidity rates skyrocket recently, leading to the maternal health crisis we are facing today. Data show that the 2020 maternal mortality rate in the U.S. was more than three times the rate in most other high-income countries, with an average of 24 deaths per 100,000 live births. And this crisis is inequitable: Black women are nearly three times more likely to die from pregnancy-related causes than white women, and American Indian and Alaska Native women two times more likely. Further, women living in rural areas, where there are often maternal health deserts, are about 60 percent more likely to die than women living in non-rural areas. And people in the trans community who become pregnant suffer disproportionate rates of parental morbidity.  

Deadly, systemic problems such as these urgently require systemwide, transformational solutions. It has taken years of direct service and advocacy to begin making some of these transformational solutions a reality. So, we stand in deep respect, gratitude, and solidarity with the decades-long work of reproductive justice and maternal health leaders advocating for equity and autonomy to improve maternal health and elevate attention to the unique challenges faced by pregnant people. And today, we’d like to focus specifically on a government entity that holds the power to quickly transform systems: the White House. 

What the Biden-Harris Administration is Doing About Maternal Health

The Biden-Harris Administration has made maternal health a central priority and is making significant strides toward improving it. In 2022, the Biden-Harris Administration released the White House Blueprint for Addressing the Maternal Health Crisis — a comprehensive set of actions to address the unacceptably high maternal morbidity and mortality rates that inequitably harm women of color. The Blueprint lays out a series of actions aimed at decreasing health disparities plaguing the nation, divided into five goals. While the actions described in the Blueprint are all important, we focus today on “Increasing Access to and Coverage of Comprehensive High-quality Maternal Health Services, Including Behavioral Health Services.” This goal is aimed at reducing gaps in coverage and improving access to high-quality maternal care across the board, to include all pregnant and postpartum people, regardless of geographical barriers. It is also foundational to achieving subsequent goals in the Blueprint. The Biden-Harris Administration has already done historic work to make progress on this goal. While the list below does not fully encompass all their actions to advance maternal health progress, we highlight specific actions by federal health agencies. 

Some examples of the impactful agency actions the Biden-Harris Administration has taken include: 

Expanding Postpartum Coverage (CMS)

As the federal agency that administers health care coverage to more than 100 million people through Medicare, Medicaid, and the Children’s Health Insurance Program, the Centers for Medicare and Medicaid Services (CMS) has the ability to significantly improve access to care and influence quality of care through health care standards and guidance.  

To improve access to and continuity of care, CMS has done outreach to states encouraging them to provide a full year of postpartum coverage through Medicaid using funding from the American Rescue Plan Act. Postpartum coverage is needed to address any adverse effects or otherwise overlooked challenges: Over half of pregnancy-related deaths in the U.S. happen between 7 days to 1 year after pregnancy, and a large majority of these unacceptable deaths are preventable. This initiative is also critical to closing health equity gaps; Black mothers — who we know face higher rates of maternity mortality — are more likely to have Medicaid coverage than U.S. mothers overall. When the Biden-Harris Administration took office in January 2021, only three states offered Medicaid coverage for 12 months after pregnancy. Their efforts since have resulted in postpartum coverage extensions in 45 states, Washington D.C., and the Virgin Islands.  

Identifying Birthing Friendly Hospitals (CMS)

To help people easily identify hospitals well-equipped to provide maternal health services, CMS launched its first iteration of a federal quality designation for hospitals with a focus on maternal health through their “Birthing Friendly” designation. This designation icon will appear on CMS’ Care Compare online tool to help patients identify hospitals and other health systems that participate in a state or nationwide perinatal quality improvement collaborative program and actively implement evidence-based care to improve maternal health.  

Helping States Deliver Whole-person Care to Mothers (CMS)

In December of 2023, CMS announced the  “Transforming Maternal Health (TMaH) Model to improve maternal and infant health by providing sustainable funding and guidance to state Medicaid agencies. The TMaH model is a 10-year payment and care delivery initiative that will help states as they develop their whole-person care approach to pregnancy, childbirth, and postpartum for people with Medicaid and CHIP coverage. There are several goals with the launch of this model, including reducing low-risk cesarean sections and maternal morbidity and increasing access to diverse types of maternal care providers, such as midwives and doulas. States that participate can receive up to $17 million during the 10-year period.  

Investing In Mothers’ Health (HRSA)

Health Resources and Services Administration (HRSA) programs support pregnant people, rural communities, people with low-incomes and others in underserved communities. HRSA has made some of the largest investments in maternal health in the past two years totaling more than $50 million including:  

• $9 million through the State Maternal Health Innovation Program to nine public health departments and universities to create maternal health task forces that include pregnant and postpartum people to develop approaches to address workforce training, community engagement, and other key issues. 
• $24 million across 20 states to enhance the maternal health task forces specifically in underserved and rural communities to focus on innovation and to improve service delivery;  
• $9 million to 12 states to expand screening and treatment for maternal depression and other mental health and substance use disorders; and more. 

Supporting Mothers Experiencing Mental Health Crises (HRSA)
Perinatal mental health conditions (including deaths to suicide and overdose) are the leading cause of maternal mortality in the U.S., leading to 23% of all maternal deaths. These rates are even higher for Black and Native American patients. We know that immediate, accessible support during moments of crisis is crucial for mental health and well-being. This is why HRSA established and expanded the National Maternal Mental Health Hotline, which gives people free access to professional counselors who can provide emotional support, referrals, and additional resources to pregnant and postpartum individuals who are managing mental health concerns.  

Waxman Recommendations for Future Administrative Action

The list above is far from exhaustive — the Biden-Harris Administration has made significant progress during its first three years. However, this is a complex problem, and a considerable amount of work remains. Below we outline some priorities for this or a future administration to continue to work to advance maternal health, though this list is not exhaustive. 

Medicaid Postpartum Coverage in all 50 States 

CMS should continue working with the remaining five states that have not implemented 12 months of postpartum coverage and should develop new opportunities to promote maternal health. CMS can work with states to identify and address barriers that may be preventing states from expanding postpartum coverage. A full year of postpartum coverage across all 50 states will help to prevent pregnancy-related deaths and ensure that mothers can access care regardless of their geographical location.  

Ongoing Inter-agency Collaboration 

There are several agencies that impact the lives and well-being of mothers beyond CMS and HRSA including the U.S. Department of Agriculture (USDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Housing and Urban Development (HUD), and more. Ensuring that agencies strategically partner to identify pathways for funding and supporting community-based organizations that can most effectively impact maternal health outcomes is an important way to decrease duplication and improve maternal health policies.  

Centering Maternal Health Equity Across Government 

Given the many federal agencies which impact lives during and after pregnancy, it is vital to ensure that maternal health advocates and leaders have opportunities to inform robust initiatives across agencies and departments. Continuing efforts to ensure that policies and staff roles include people who have deep experience with the issues related to maternal health equity must be a continued priority for any administration. Supporting maternal health leaders to collaborate across agencies will enable them to address multiple social determinants of health to help future mothers safely carry out a pregnancy. 

Setting the Standard  

The administration should ensure that the health and leave benefits offered to federal employees are aligned with the highest standards rooted in evidence-based practices to support mothers. It should then develop actionable guidance that is publicly available for employers throughout the U.S. on how to get their employee’s plans up to the highest standard. Leading by example and providing the tools for employers to be supportive of their staff will pay dividends in improving the quality of life for families across the nation.  

Public Awareness Campaign  

The administration should continue to launch comprehensive public awareness campaigns to draw attention to maternal health opportunities, prenatal care, and new services available to the public. New initiatives and investments – such as the maternal mental health hotline and a full year of postpartum Medicaid coverage in many states – are only useful when people know about them and can actively take advantage of them. Recognizing that the maternal health crisis is a systemic issue, policymakers should take steps towards addressing these problems by providing resources and developing tools that meet mothers where they are and are easily accessible to promote their health and save lives.  

Looking Forward 

This Mother’s Day serves as a poignant reminder of the ongoing need to champion comprehensive maternal health care for all individuals. At Waxman Strategies, we advocate for a future where every mother can thrive with dignity, respect, and access to the care they deserve. We are confident that the White House will continue making significant strides to enhance maternal health and look forward to partnering with those who share our values.  

If you would like to talk to us about these issues, please contact Silicia Lomax (silicia@waxmanstrategies.com)