PROJECTStrong Start for Mothers and Newborns


The Strong Start for Mothers and Newborns initiative, funded under the Affordable Care Act, aimed to improve maternal and infant outcomes for women covered by Medicaid and the Children’s Health Insurance Program during pregnancy. The initiative funded enhanced services through three evidence-based prenatal care models—Birth Centers, Group Prenatal Care, and Maternity Care Homes—and supported the delivery of these services through 27 awardees and more than 200 provider sites across 32 states, the District of Columbia, and Puerto Rico. Four-year cooperative agreements were awarded in 2013 by the Center for Medicare and Medicaid Innovation of the Centers for Medicare and Medicaid Services. Strong Start awardees comprised a wide variety of organizations, including hospital and health systems, health plans, and community-based providers and agencies. 

The Center for Medicare and Medicaid Innovation contracted with the Urban Institute to conduct an independent, five-year evaluation of Strong Start implementation and the program’s impacts on maternal and infant health outcomes, health care delivery, and cost of care. The evaluation set out to answer the following key research questions:

  • How does Strong Start prenatal care differ from typical Medicaid maternity practice?

  • What are the characteristics of Strong Start participants?

  • What is Strong Start’s impact on outcomes (gestational age, birth weight, and costs)?

To answer these questions, the evaluation included three primary components:

  • qualitative case studies of how Strong Start approaches were designed, were implemented, and evolved over time

  • participant-level process evaluation of the demographic and risk characteristics, service use, and outcomes of all Strong Start participants

  • analysis of Strong Start’s impact on rates of preterm birth, low-birthweight births, and Medicaid/Children’s Health Insurance Program costs through pregnancy and the first year after birth.

The evaluation’s final annual report, as well as peer-reviewed publications derived from the evaluation, are linked below:

Intensive Approaches to Prenatal Care May Reduce Risk of Gestational Diabetes
Midwifery and Birth Centers Under State Medicaid Programs
Improving Birth Outcomes And Lowering Costs For Women On Medicaid
Prenatal Depression: Assessment and Outcomes among Medicaid Participants
Twin Births in Medicaid: Prevalence, Outcomes, Utilization, and Cost in Four States, 2014–2015
Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices
Strategies to Promote Postpartum Visit Attendance among Medicaid Participants
What do women in Medicaid say about enhanced prenatal care? Findings from the national Strong Start evaluation
Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013–2016
Strong Start for Mothers and Newborns Evaluation: Year 5 Project Synthesis
Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants
Facilitators and Barriers to Healthy Pregnancy Spacing among Medicaid Beneficiaries

Visit the Centers for Medicare & Medicaid Services website for more information on the Strong Start Initiative.

Research Areas Health and health care
Policy Centers Health Policy Center