Blog Post

Could the Future of Your Obstetrics Service Line Be Dependent on Maternal Care Designations?

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Texas rolled out a new “maternal levels of care” hospital designation in March 2018. The designation requires that all hospitals providing obstetric (OB) services gain approval from the state to provide one of four maternal care levels (much like a neonatal intensive care unit or trauma facility designation). After 2020, a hospital without this designation will no longer be eligible for Medicaid reimbursement for OB care.

The American College of Obstetricians and Gynecologists (ACOG) began calling for these types of designations in 2015, and several other states (e.g., Indiana, Arizona, Maryland) have already incorporated maternal care designations into regulations for facilities providing OB services in their states. This year, Georgia passed a bill designating perinatal levels of care, and other states are likely to follow suit. The goals of these four designation levels are to improve maternal and newborn outcomes and reduce healthcare costs. So how do you prepare for the changes?

Maternal Levels of Care: ACOG Definitions

While the exact specifications for each maternal care level vary from state to state, they generally follow ACOG’s recommended definitions 1, ranging from birth centers to comprehensive acute care requirements. In the table below, you’ll find descriptions of these requirements and the typical conditions that may be treated at each level.

Obstetric Care Volume and Maternal Care Designation

In Texas, where obtaining the maternal care designation is tied to Medicaid reimbursement, hospitals stand to lose a significant revenue source if they do not receive a designated status (the deadline for applying is September 2018). According to the Kaiser Family Foundation, 54% of births in Texas are covered by Medicaid—meaning that hospitals currently providing OB services could lose half their volume by 2020 without a designation. Nationally, it is estimated that 40% of births are covered by Medicaid 2, indicating that should other states choose to associate Medicaid payments with maternal care designations, it would have major financial implications for most hospitals. Georgia is currently considering similar regulations, and several other states are considering following suite.

Preparing for the Maternal Care Designations

Regardless of what position an organization’s home state currently takes on maternal designations, taking steps to prepare for the implementation of designations can help prioritize investments and create efficiencies in the service line. Here are some recommended action items for organizations that may be affected:

  • Determine Strategic Direction. Consider a realistic assessment of the competitive environment, birth volume trends, placement within a portfolio of services, and alignment with the organizational strategic plan.
  • Conduct a Gap Assessment: Identify areas where opportunities exist and infrastructure investments are needed to meet the requirements for the desired designation level.
  • Develop an Action Plan: Prepare a plan outlining the tasks, resource requirements, and timeline needed to close the gaps between the current and desired states.
  • Conduct a Mock Survey: Use survey tools to test how your current infrastructure, resources, staffing, and policies align with best practices and requirements—and address the remaining gaps.
  • Apply for Maternal Designation: Complete the application before the stated deadline.

Five states have already implemented maternal care designations, and more states are likely to follow suit to influence and improve outcomes while mitigating rising costs. America lags almost every other industrialized nation in terms of maternal morbidity and mortality and regulators, payers, and providers will continue to prioritize ensuring women are cared for at appropriate facilities with appropriate resources.


  • 1.

    “Obstetric Care Consensus No. 2: Levels of Maternal Care,” American College of Obstetricians and Gynecologists, Obstet Gynecol 2015;125:502-15.

  • 2.

    “Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017,” The Henry J. Kaiser Family Foundation, October 2016.