New Government Initiative: Strong Start For Mothers & Newborns

The Department of Health and Human Services initiative, Strong Start for Mothers and Newborns, aims to reduce preterm births and improve outcomes for newborns and pregnant women.  CMS recently announced the two strategies of this initiative to achieve these goals:

  •  A public-private partnership and awareness campaign to reduce the rate of early elective deliveries prior to 39 weeks for all populations.
  • A funding opportunity to test the effectiveness of specific enhanced prenatal care approaches to reduce the frequency of premature births among pregnant Medicaid or Children’s Health Insurance Program (CHIP) beneficiaries at high risk for preterm births. 

The Strong Start effort to test new approaches to prenatal care is a four-year initiative to test and evaluate enhanced prenatal care interventions for women enrolled in Medicaid or CHIP who are at risk for having a preterm birth.  

The goals are:

1.       Determine if these approaches to care can reduce the rate of preterm births

2.       Improve the health outcomes of pregnant women and newborns

3.       Decrease the anticipated total cost of medical care during pregnancy, delivery, and over the first year of life for children born to mothers in Medicaid or CHIP.


Three approaches to enhanced prenatal care

This initiative will test three evidence-based maternity care service approaches that enhance the current care delivery and address the medical, behavioral, and psychosocial factors that may be present during pregnancy and contribute to preterm-related poor birth outcomes.  Awardees will test one of the three following interventions but cannot use funds to supplement or supplant any funding sources, including Medicaid and CHIP reimbursement:

  • Group prenatal care that incorporates peer-to-peer interaction in a facilitated setting for health assessment, education, and psycho-social support.
  • Comprehensive prenatal care facilitated by teams of health professionals, including peer counselors.  Services include collaborative practice, intensive case management, counseling, and psycho-social support.
  • Enhanced prenatal care including psychosocial support, education, and health promotion in addition to traditional prenatal care.   Services provided will expand access to care, improve care coordination, and provide a broader array of health services. 

Awardees receiving Strong Start funds can administer more than one approach to enhanced prenatal care at multiple provider sites; however, individual provider sites can administer only one of the three enhanced approaches. 

Strong Startawardees will be serving women in the areas with the highest preterm birth rates in the country, including areas that are among the top ten prematurity and infant mortality counties according to the Centers for Disease Control and Prevention.  

Eligibility criteria

 To be eligible to participate in the Strong Start initiative, applicants had to be:

1.   Providers of obstetric care(for example, provider groups or affiliated providers and facilities);

2.   State Medicaid Agencies, in partnership with providers;

3.   Medicaid managed care organizations (MCOs), in partnership with providers; or

4.   Conveners in partnership with other applicants.  The convener could be a direct applicant or could convene and support other organizations to become applicants. 

      Examples of conveners include professional trade associations or other health service related organizations.

Program requirements

Strong Startawardees will participate in monitoring and evaluation activities to ensure that quality care is being delivered:

  • Participants will be expected to provide the CMS Innovation Center performance metrics consistent with the goals of the initiative on a quarterly basis.
  • Awardees will report information on gestational age and birth weight for the infants of the mothers participating in one of the three approaches to enhanced prenatal care.
  • Participants will also provide the gestational age and birth weight data on births from a historical baseline period that spans at least two years prior to the start of the intervention.
  • Participants also submit quarterly progress reports on the specific uses of the cooperative agreement funds, assessment of the overall project implementation, and other specific information.
  • They must also submit quarterly data reporting on operations, utilization, and outcomes.


CMSwill provide technical assistance, analytic support, and coordination to help participants launch their interventions to reduce premature births.  As with all Innovation Center initiatives, participants will participate in opportunities for shared learning and dissemination with others.  

About the Innovation Center

 The CMS Innovation Center was created by the Affordable Care Act to test new innovative payment and service delivery models.  The Center is committed to testing models to help the Medicare, Medicaid, and CHIP programs deliver better care for beneficiaries while reducing costs.

For more information

 Additional information on the Strong Start initiative is available on the Strong Start website at: