States Continue to Fail Mothers
Top Lines:
- The U.S. has made minimal progress, with an overall grade of a D+, improving slightly from a D in 2023
- 29 states earned Ds and Fs in 2024, compared to 40 in 2023
- 34 states’ scores improved, with four states vs one now earning B grades and five states vs 15 earning Fs
Introduction
In 2023, recognizing that in the U.S., responsibility for healthcare systems and health outcomes largely fall to the states, the Policy Center introduced the inaugural maternal mental health reports to identify key data sets and track results by state. The 2024 report cards highlight progress and remaining areas of opportunity.
In 2024, the overall national grade improved slightly from a D to a D+ as state grades inched upwards. Thirty-four state grades improved; four states earned Bs (an increase from 1 state in 2023) and five states earned failing grades (down from 15 states in 2023).
Measures
Three new measures were introduced in 2024:
- HEDIS prenatal depression screening greater than 10% (among commercial insurance and/or Medicaid)
- HEDIS postpartum depression screening greater than 10% (among commercial insurance and/or Medicaid)
- State has a Perinatal Quality Collaborative (PQC) that has prioritized MMH
One measure was replaced
- OBs required to screen for MMH: This measure, which provided credit for states with obstetric provider screening mandates, was retired and replaced by the two new HEDIS screening measures noted above. It’s important to note, however, that the current HEDIS measures are reported by health insurers/plans, and the HEDIS specifications allow for credit regardless of who screens enrollees (the measure does not report OB screening rates exclusively). Further, the measure developer, the National Committee for Quality Assurance, has not yet made this measure mandatory for accredited insurers/plans.
One measure was paused
- Medicaid reimburses OBs for MMH screening: This measure was paused in 2024, as this dataset no longer exists from outside sources. In the future, the Policy Center will develop and maintain this data set.
Two measures were supplemented
- This year a new data set of providers was included, the Marce of North America’s list of Reproductive Mental Health Academic Programs in the U.S. It includes additional MMH prescribers and non-prescriber MMH providers, supplementing measures 1 (non-prescriber MMH providers to perinatal population ratio) and 2 (mental health provider prescriber providers to perinatal population ratio).
Learn more about the measures and methods here.
Results
In 2024, 34 states increased their grades. Following is a summary:
Table 1:
| STATES | 2023 | 2024 |
|---|---|---|
| B grades | 1 state (CA) | 4 states (CA, PA, UT, WA) |
| C grades | 10 states | 19 states |
| D grades | 25 states | 24 states |
| Failing grades | 15 states | 5 states (AL, AR, NV, SD, MS) |
The detailed state grade changes from 2023 to 2024 can be found below.
Table 2:
| State | 2023 Grade | 2024 Grade | What Changed |
|---|---|---|---|
| AL | F | F | · Grade unchanged |
| AK | D- | D | + Extended Medicaid coverage to one year postpartum + Increased postpartum MMH screening claims submitted by obstetric providers to private insurers |
| AZ | C | C | · Grade unchanged. Note: AZ has retained points from a “paused” measure, “Medicaid reimburses OBs for MMH screening”. |
| AR | F | F | + Increased prenatal MMH treatment claims submitted by providers to private insurers – Lost points due to fewer postpartum MMH screening claims being submitted by obstetric providers to private insurers · Grade unchanged: gains offset losses |
| CA | B- | B+ | + Met the MMH prescriber ratio + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) · Note: CA has retained points from a “paused” measure, “Medicaid reimburses OBs for MMH screening” |
| CO | C | C | + PQC prioritizes MMH (new measure) + Additional CBO providing MMH services – Lost points due to a retired measure (“Medicaid reimburses OBs for MMH screening”) which was replaced by the two new screening measures (HEDIS “prenatal depression screening” and HEDIS “postpartum depression screening”) · Grade unchanged; losses were offset by gains. Note: CO has retained points from a “paused” measure, “Medicaid reimburses OBs for MMH screening” |
| CT | F | D- | + Increased prenatal MMH treatment claims submitted by providers to private insurers + Increased postpartum MMH treatment claims submitted by providers to private insurers |
| DC | D+ | C | + Additional CBOs providing MMH services + Gained an intensive outpatient program + Increased prenatal MMH treatment claims submitted by providers to private insurers |
| DE | D- | D+ | + Met the MMH prescriber ratio + Additional CBOs providing MMH services + Increased prenatal MMH screening claims submitted by obstetric providers to private insurers + Increased prenatal MMH treatment claims submitted by providers to private insurers |
| FL | D | D+ | + Gained an additional outpatient hospital program · Note: FL has retained points from a “paused” measure, “Medicaid reimburses OBs for MMH screening” |
| GA | F | D | + Additional CBOs providing MMH services + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) + Increased prenatal screening claims submitted by obstetric providers to private insurers |
| HI | D | D | · Grade unchanged |
| ID | F | D | + Met the MMH prescriber ratio + Extended Medicaid coverage to one year postpartum |
| IL | C | C | + Met the MMH prescriber ratio – Lost points due to a retired measure (“Medicaid reimburses OBs for MMH screening”) which was replaced by the two new screening measures (HEDIS “prenatal depression screening” and HEDIS “postpartum depression screening”) · Grade unchanged: gains offset losses. (Note: IL has retained points from a “paused” measure, “Medicaid reimburses OBs for MMH screening.) |
| IN | D | D+ | + Additional CBOs providing MMH services + Increased postpartum MMH treatment claims submitted by providers to private insurers – Lost points due to decreased postpartum MMH screening claims submitted by obstetric providers to private insurers |
| IA | F | D- | + Met the MMH prescriber ratio |
| KS | D- | D | + Increased postpartum MMH treatment claims submitted by providers to private insurers |
| KY | D- | D | + Met the MMH prescriber ratio + PQC prioritizes MMH (new measure) |
| LA | D+ | D+ | + PQC prioritizes MMH (new measure) + Increased prenatal MMH treatment claims submitted by providers to private insurers – Lost points due to a retired measure “OBs must screen for MMH” which was replaced by the two new screening measures (HEDIS “prenatal depression screening” and HEDIS “postpartum depression screening”) · Grade unchanged: gains offset losses |
| ME | D- | D- | + PQC prioritizes MMH (new measure) · Grade unchanged: gains not enough to raise a letter grade |
| MD | C- | C | + Increased prenatal MMH screening claims submitted by obstetric providers to private insurers + Increased postpartum MMH screening claims submitted by obstetric providers to private insurers |
| MA | C | C | + Additional CBO providing MMH services · Grade unchanged: gains not enough to raise a letter grade |
| MI | D | D+ | + Increased prenatal MMH screening claims submitted by obstetric providers to private insurers + Increased postpartum MMH screening claims submitted by obstetric providers to private insurers |
| MN | D+ | C | + Met the MMH prescriber ratio + Postpartum MMH screening >10% via HEDIS (new measure) + Increased prenatal MMH treatment claims submitted by providers to private insurers – Decreased postpartum MHH screening claims submitted by obstetric providers to private insurers |
| MS | F | F | · Grade unchanged |
| MO | D- | D+ | + Met the MMH prescriber ratio + PQC prioritizes MMH (new measure) + Extended Medicaid coverage to one year postpartum |
| MT | D+ | D+ | + Additional CBO providing MMH services + Extended Medicaid coverage to one year postpartum – Lost points due to not meeting the non-prescriber MMH provider ratio in 2024. (This loss was due to a slight change in Measure #1’s structure: in 2023, Measure #1 captured all PMH-Cs, including prescribers; in 2024, prescribers are exclusively included in Measure #2.) · Grade unchanged: gains offset losses |
| NE | F | D | + Met the MMH prescriber ratio + PQC prioritizes MMH (new measure) + Extended Medicaid coverage to one year postpartum |
| NH | F | D+ | + Met the MMH prescriber ratio + Additional CBO providing MMH services + PQC prioritizes MMH (new measure) + Extended Medicaid coverage to one year postpartum |
| NJ | C- | C- | + PQC prioritizes MMH (new measure) + Increased postpartum MMH treatment screening claims submitted by providers to private insurers · Grade unchanged |
| NM | F | D+ | + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) + Increased prenatal MMH treatment claims submitted by providers to private insurers |
| NY | D | C | + Met the MMH prescriber ratio + Added a MMH Task Force + Increased postpartum MMH screening claims submitted by obstetric providers to private insurers + Increased prenatal MMH treatment claims submitted by providers to private insurers |
| NC | D | C- | + Met the MMH prescriber ratio + Expanded Medicaid |
| ND | D- | D- | · Grade unchanged |
| OH | D+ | C- | + Gained additional outpatient program + Increased prenatal MMH treatment claims submitted by providers to private insurers |
| OK | D+ | D+ | + PQC prioritizes MMH (new measure) + Additional CBO providing MMH services – Lost points due to a retired measure “OBs must screen for MMH” which was replaced by the two new screening measures (HEDIS “prenatal depression screening” and HEDIS “postpartum depression screening”) · Grade unchanged: gains offset losses |
| OR | D+ | C- | + Additional CBO providing MMH services |
| PA | C | B- | + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) |
| RI | C- | C- | · Grade unchanged |
| SC | F | D- | + Additional CBO providing MMH services + Increased MMH postpartum treatment claims submitted to providers to private insurers |
| SD | F | F | + Expanded Medicaid + Extended Medicaid coverage to one year postpartum + Increased prenatal MMH treatment claims submitted by providers to private insurers – Lost points due to decreased providers billing private insurers for postpartum MMH treatment · Grade unchanged: gains offset losses |
| TN | D | C- | + Met the MMH prescriber ratio + Additional CBO providing MMH services + Increased postpartum MMH screening claims submitted by obstetric providers to private insurers + Increased prenatal MMH treatment claims submitted by providers to private insurers |
| TX | F | D | + Three additional CBOs providing MMH services + Extended Medicaid coverage to one year postpartum |
| UT | D | B- | + Met the MMH prescriber ratio + Additional CBO providing MMH services + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) + PQC prioritizes MMH (new measure) + Extended Medicaid coverage to one year postpartum + Added a MMH Task Force – Lost points due to decreased postpartum MMH treatment claims submitted by providers to private insurers |
| VT | D+ | C | + Met the MMH prescriber ratio + PQC prioritizes MMH (new measure) + Increased prenatal MMH screening claims submitted by obstetric providers to private insurers |
| VA | D- | C | + Met the MMH prescriber ratio + Gained an additional outpatient program + PQC prioritizes MMH (new measure) + Increased postpartum MMH screening claims submitted by obstetric providers to private insurers + Increased prenatal MMH treatment claims submitted by providers to private insurers + Increased postpartum MMH treatment claims submitted by providers to private insurers · Note: VA has retained points from a “paused” measure, “Medicaid reimburses OBs for MMH screening” |
| WA | C- | B- | + Met the MMH prescriber ratio + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) |
| WV | D- | C- | + Met the MMH prescriber ratio + Increased prenatal MMH treatment claims submitted by providers to private insurers + Increased postpartum MMH treatment claims submitted by providers to private insurers |
| WI | D | C | + Prenatal MMH screening >10% via HEDIS (new measure) + Postpartum MMH screening >10% via HEDIS (new measure) |
| WY | F | D- | + Met the MMH prescriber ratio – Lost points due to decreased postpartum MMH treatment submitted submitted by providers to private insurers |
