19 states earned Ds and Fs
Top Lines:
- The U.S. has made incremental progress, with an overall grade of a C-, improving slightly from a D+ in 2024.
- 26 states’ scores improved in 2025: 19 states earned Ds and Fs, compared to 29 in 2024.
- Five states earned B grades (CA, CO, MI, PA, and WA), with MI and WA earning Bs for the first time. No states earned As.
- MI has the most notable improvement in its grade, improving substantively from a D+ to a B-, improving in several areas, and most notably for screening to detect maternal mental health disorders.
- Just 2 states continue to have failing grades (AL and MS).
Introduction
In 2023, given that states largely hold the responsibility for health outcomes, the Policy Center for Maternal Mental Health (“Policy Center”) introduced the maternal mental health (MMH) report cards to identify key data sets and track results by state. The 2025 report cards highlight progress, areas of opportunity, and serve as a roadmap for states to improve maternal mental health.
In 2025, the overall national grade improved slightly from a D+ to a C- as state grades inched upwards. Twenty-six state grades improved; 5 states earned Bs (an increase from 3 states in 2024) and 2 states earned failing grades (down from 5 states in 2024).
Measures
The 2025 Maternal Mental Health (MMH) state report cards include 20 measures across 3 domains:
- Providers and Programs
- Screening: Results, Requirements, and Reimbursement
- Insurance Coverage and Treatment Reimbursement
Both measures were added to the “Insurance Coverage and Treatment Reimbursement” domain:
- State provides enhanced Medicaid reimbursement or state investment in group prenatal care (1 point)
- Medicaid coverage of group parenting programs (2 points)
States were awarded points if they met these new measures. However, states were not penalized if they did not meet these new measures, and their grades did not drop as the overall point/grading system has stayed the same ( A = 38+ points; B+ = 35-37 points; B = 29-4; etc). Learn more about the measures here.
Results
In 2025, as noted in the “Top Lines” above, 5 states earned the highest grade of B, and 2 states retained Fs, while the others earned Cs and Ds.
| State grades | 2025 |
|---|---|
| B grades | 5 states (CA, CO, MI, PA, WA) |
| C grades | 27 states |
| D grades | 17 states |
| Failing grade | 2 states (AL, MS) |
Year over year, states have improved, with states moving up in all grade categories:
| STATES | 2023 | 2024 | 2025 |
|---|---|---|---|
| B grades | 1 state (CA) | 3 states (CA, PA, WA) | 5 states (CA, CO, MI, PA, WA) |
| C grades | 10 states | 19 states | 27 states |
| D grades | 25 states | 24 states | 17 states |
| Failing grades | 15 states | 5 states (AL, AR, NV, SD, MS) | 2 states (AL, MS) |
Twenty-five states increased their grades, and two states’ grades fell (OK and UT).
| State | 2023 Grade | 2024 Grade | 2025 Grade | What Changed in 2025? |
|---|---|---|---|---|
| AL | F | F | F | + Additional CBOs providing MMH services · Grade unchanged: gains not enough to raise a letter grade |
| AK | D- | D | C- | + Postpartum MMH screening is now >10% via HEDIS |
| AZ | C | C | C | + Medicaid covers group parenting programs (new measure) · Grade unchanged: gains not enough to raise a letter grade |
| AR | F | F | D | + Gained an inpatient program + Postpartum MMH screening is now >10% via HEDIS |
| CA | B- | B+ | B+ | + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) · Grade unchanged: gains not enough to raise a letter grade |
| CO | C | C | B- | + Gained an intensive outpatient program + Prenatal MMH screening is now >10% via HEDIS + Postpartum MMH screening is now >10% via HEDIS |
| CT | F | D- | D | + Met the MMH prescriber ratio |
| DC | D+ | C | C | + Met the MMH non-prescriber ratio · Grade unchanged: gains not enough to raise a letter grade |
| DE | D- | D+ | D+ | · Grade unchanged |
| FL | D | D+ | C- | + Additional Community Based Organization providing MMH services |
| GA | F | D | D | · Grade unchanged |
| HI | D | D | D+ | + Met the MMH prescriber ratioAdditional CBO providing MMH services |
| ID | F | D | D | · Grade unchanged |
| IL | C | C | C | + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) · Grade unchanged: gains not enough to raise a letter grade |
| IN | D | D+ | C | + Met the MMH prescriber ratioPrenatal MMH screening is now >10% via HEDIS + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| IA | F | D- | C | + Prenatal MMH screening >10% via HEDIS + Postpartum MMH screening >10% via HEDIS + Extended Medicaid coverage to one year postpartum |
| KS | D- | D | D | + Perinatal Quality Collaborative prioritizes MMH · Grade unchanged: gains not enough to raise a letter grade |
| KY | D- | D | C- | + Gained a MMH Task Force + Medicaid covers group parenting programs (new measure) |
| LA | D+ | D+ | C+ | + Met the MMH prescriber ratioGained an inpatient or residential program + Additional Community-Based Organization providing MMH services + Prenatal MMH screening is now >10% via HEDIS + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) + Medicaid covers group parenting programs (new measure) |
| ME | D- | D- | D | + Met the MMH prescriber ratio |
| MD | C- | C | C | + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) · Grade unchanged: gains not enough to raise a letter grade |
| MA | C | C | C+ | + Perinatal Quality Committee prioritizes MMH + Medicaid covers group parenting programs (new measure) |
| MI | D | D+ | B- | + Met the MMH prescriber ratio + Perinatal Quality Committee prioritizes MMH + Prenatal MMH screening is now >10% via HEDIS + Postpartum MMH screening is now >10% via HEDIS + Requires Medicaid health plans to report the prenatal MMH screening measure + Requires Medicaid health plans to report the postpartum MMH screening measure + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| MN | D+ | C | C | · Grade unchanged |
| MS | F | F | F | · Grade unchanged |
| MO | D- | D+ | D+ | + Additional CBOs providing MMH services – Lost points for no longer requiring Medicaid health plans to report the prenatal MMH screening measure · Grade unchanged: gained points offset lost points |
| MT | D+ | D+ | C- | + Met the MMH non-prescriber provider ratio + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| NE | F | D | D | · Grade unchanged |
| NH | F | D+ | C- | + Requires Medicaid health plans to report the postpartum MMH screening measure |
| NJ | C- | C- | C- | – Lost points for state Perinatal Quality Collaborative no longer prioritizing MMH + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) – Grade unchanged: gained points offset lost points |
| NV | F | F | D+ | + Met the MMH prescriber ratio + Requires Medicaid health plans to report the prenatal MMH screening measure + Requires Medicaid health plans to report the postpartum MMH screening measure |
NM | F | D+ | C | + Met the MMH prescriber ratio + Additional Community-Based Organization providing MMH services + Requires Medicaid health plans to report the prenatal MMH screening measure + Requires Medicaid health plans to report the postpartum MMH screening measure + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| NY | D | C | C | + Gained an intensive outpatient program + Medicaid covers group parenting programs (new measure) · Grade unchanged: gains not enough to raise a letter grade |
| NC | D | C- | C- | + Additional Community Based Organization providing MMH services · Grade unchanged: gains not enough to raise a letter grade |
| ND | D- | D- | D | + Postpartum MMH screening is now >10% via HEDIS |
| OH | D+ | C- | C | + Met the MMH prescriber ratio + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| OK | D+ | D+ | D | – Lost points for lapsed MMH Task Force |
| OR | D+ | C- | C- | · Grade unchanged |
| PA | C | B- | B | + Met the MMH prescriber ratio |
| RI | C- | C- | C | + Gained an intensive outpatient programMedicaid covers group parenting programs (new measure) |
| SC | F | D- | D | + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| SD | F | F | D | + Postpartum MMH screening is now >10% via HEDIS + Additional Community Based Organization providing MMH services |
| TN | D | C- | C | + Postpartum MMH screening is now >10% via HEDIS |
| TX | F | D | D+ | + Gained an intensive outpatient program +State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| UT | D | C+ | C | – Lost points due to prenatal MMH screening falling < 10% via HEDIS – Lost points due to postpartum MMH screening falling < 10% via HEDIS + State provides enhanced Medicaid reimbursement or state investment in group prenatal care (new measure) |
| VT | D+ | C | C | · Grade unchanged |
| VA | D- | C | C | · Grade unchanged |
| WA | C- | B- | B- | · Grade unchanged |
| WV | D- | C- | C- | · Grade unchanged |
| WI | D | C | C | + Met the MMH prescriber ratio + Additional community based organization providing MMH services · Grade unchanged: gains not enough to raise a letter grade |
| WY | F | D- | D | + Postpartum MMH screening is now >10% via HEDIS |
The states that met each of the 20 measures in 2025 can be found below.
| 2025 MMH State Report Card Measure | Number of States Meeting the Measure |
|---|---|
| 1. Meets ratio of non-prescriber MMH providers to perinatal population (5 per 1,000 births) | 2 states and DC meet the MMH non-prescriber ratio: DC, MT, VT Did anything change in 2025? Yes, DC and MT met this measure for the first time. |
| 2. Meets ratio of MMH prescribers to perinatal population (1 per 5,000 births) | 40 states and DC meet the MMH prescriber ratio. The 10 states that do not meet this measure include: AL, AR, FL, GA, MS, ND, OK, SC, SD, TX. Did anything change in 2025? Yes, 11 states met this measure for the first time: CT, HI, IN, LA, MN, MI, NM, NV, OH, PA, WI. |
| 3. Has at least one inpatient or residential MMH treatment program | 5 states have MMH inpatient or residential programs: AR, CA, LA, NC, NY Did anything change in 2025? Yes, AR and LA met this measure for the first time. |
| 4. Has at least one MMH outpatient intensive (IOP) or partial hospitalization program (PHP) | 18 states and DC have MMH outpatient programs Did anything change in 2025? Yes, 2 states met this measure for the first time (CO and TX), and 2 states gained additional outpatient programs (NY and RI). |
| 5. Has or has had a state-sanctioned MMH Task Force or Commission | 13 states and DC have an MMH Task Force: AZ, CA, DC, FL, KY, LA, MA, MD, NY, OH, OR, TN, TX Did anything change in 2025? Yes, KY met this measure for the first time. |
| 6. Meets ratio of community-based organizations providing direct service for MMH (at least 1 per 50,000 births) | 38 states and DC meet the MMH Community-Based Organization (CBO) ratio Did anything change in 2025? Yes, 7 states met this measure for the first time: AL, FL, LA, MO, NC, NM, SD, and 2 states gained additional CBOs (HI, WI). |
| 7. State Perinatal Quality Collaborative (PQC) has prioritized MMH | 15 states’ PQCs make MMH a priority: CO, KS, KY, LA, MA, ME, MI, MO, NE, NH, OK, UT, VA, VT, WA Did anything change in 2025? Yes, 3 states met this measure for the first time: KS, MS, MI, and 1 state no longer met this measure: NJ. |
| 8. State is a top performer on the HEDIS “prenatal depression screening” measure (among commercial insurance and/or Medicaid) | 10 states have a MMH prenatal screening rate >10%: CA, CO, IA, IN, LA, MI, NM, PA, WA, WI Did anything change in 2025? Yes, 5 additional states met this measure (CO, IA, IN, LA, MI), and one state no longer met this measure (UT). |
| 9. State is a top performer on the HEDIS “postpartum depression screening” measure (among commercial insurance and/or Medicaid) | 16 states have a MMH postpartum screening rate >10%: AK, AR, CA, CO, GA, IA, MI, MN, ND, NM, PA, SC, TN, WA, WI, WY Did anything change in 2025? Yes, 9 additional states met this measure: AK, AR, CO, IA, MI, ND, SD, TN, WY, and 1 state no longer met this measure UT. |
| 10. Medicaid requires MCOs to report “prenatal depression screening” HEDIS measure | 9 states require Medicaid health plans to collect prenatal HEDIS measure: CA, IN, MI, NC, NM, NV, PA, WI, WA Did anything change in 2025? Yes, 3 additional states met this measure: MI, NM, NV. |
| 11. Medicaid requires MCOs to report “postpartum depression screening” HEDIS measure | 8 states require Medicaid health plans to collect postpartum HEDIS measure: CA, MI, NH, NM, NV, PA, WA, WI Did anything change in 2025? Yes, 4 additional states met this measure (MI, NH, NM, NV), and 1 state no longer met this measure (MO). |
| 12. Maternity providers submit claims to private insurers for prenatal MMH screening (among at least 1% of prenatal patients) | 8 states had providers submit claims to private insurers among at least 1% of patients: AZ, DE, MD, MI, MN, RI, VT, WA Did anything change in 2025? No, the dataset has remained the same since the 2024 report cards. |
| 13. Maternity providers submit claims to private insurers for postpartum MMH screening (among at least 1% of postpartum patients) | 19 states had providers submit claims to private insurers among at least 1% of patients1 state had OB/Gyns in particular submit claims to private insurers among at least 1% of patients: CO Did anything change in 2025? No, the dataset has remained the same since the 2024 report cards. |
| 14. Expanded Medicaid | 40 states and DC expanded Medicaid. The 10 states that have not expanded coverage include AL, FL, GA, KS, MS, SC, TN, TX, WI, and WY. Did anything change in 2025? No additional states expanded Medicaid since the 2024 report card release. |
| 15. Extended Medicaid coverage to one year postpartum | 48 states and DC extended Medicaid coverage to 1 year postpartum. The two states that have not extended coverage include AR and WI. Did anything change in 2025? Yes, IA met this measure for the first time in 2025. |
| 16. Requires health plans to develop a MMH quality management program | 2 states require health plans to develop a MMH QI program: CA, LA Did anything change in 2025? No additional states met this measure since the 2024 report card release. |
| 17. Providers submit claims to private insurers for prenatal MMH treatment | 39 states and DC had providers submit claims to private insurers for at least 10% of patients8 states and DC had providers submit claims to private insurers among at least 15% of patients: DC, DE, MA, MN, OH, PA, RI, VT, WV (earning 3 points vs. 1 point). Did anything change in 2025? No, the dataset has remained the same since the 2024 report cards. |
| 18. Providers submit claims to private insurers for postpartum MMH treatment | 33 states and DC had providers bill at least 10% of the time 2 states had providers bill at least 15% of the time: RI, WV (earning 3 points vs 1 point). Did anything change in 2025? No, the dataset has remained the same since the 2024 report cards. |
| 19. State provides enhanced Medicaid reimbursement or state investment in group prenatal care | 13 states provide enhanced Medicaid reimbursement or state investment in group prenatal care: CA, IL, IN, LA, MD, MI, MT, NJ, NM, OH, SC, TX, UT Did anything change in 2025? This measure is new as of 2025. |
| 20. Medicaid coverage of group parenting programs without child diagnosis | 6 states provide Medicaid coverage of group parenting programs without child diagnosis: AZ, KY, LA, MA, NY, RI Did anything change in 2025? This measure is new as of 2025. |
What can states do to increase their grades in 2026?
There are several areas where states can focus their attention to raise their report card grades in 2026.
- 48 states do not have enough therapists with specialties in MMH disorders (PMH-Cs or other reproductive health training).
- 45 states and DC lack MMH inpatient or residential treatment programs
- 31 states lack MMH outpatient intensive or partial hospitalization treatment programs
- 40 states and DC have low prenatal depression HEDIS screening rates
- 34 states and DC have low postpartum depression HEDIS screening rates
The Policy Center has created a Maternal Mental Health roadmap to support states in addressing these gaps, which can further support state legislatures and agencies in implementing evidence-based policy solutions.
