A recent article in Health Affairs Forefront argues that threats to policies, programs, and data systems will substantially set back progress made over the past few years in addressing the maternal and infant mortality. As a group of experts who previously served as federally-appointed members of the US Department of Health and Human Services (HHS) Secretary’s Advisory Committee on Infant and Maternal Mortality (SACIM)—established in 1991 and renamed the Advisory Committee on Infant and Maternal Mortality (ACIMM) in 2021—we focused on Medicaid, Healthy Start, and maternal and child health data.
Medicaid: Our article affirms that health care coverage is essential for improving health outcomes, and that by design, Medicaid is the anchor for efforts to improve maternal and infant health. As SayAhhh! readers know, more than 4 in 10 U.S. births are financed by Medicaid, and (48 and District of Columbia) have opted to extend Medicaid postpartum coverage from 60 days to one full year. However, the One Big Beautiful Bill Act (OBBBA, P.L. 119-21) over the coming decade which threatens women’s and children’s health. Among the 7.5 million people the Congressional Budget Office estimates will lose Medicaid and CHIP coverage as a result of OBBBA are millions of women in their childbearing years for whom health coverage helps to ensure health before, during, and beyond pregnancy. In addition, many pregnant and postpartum women, as well as , which leaves states in a position to end their eligibility when grappling with federal Medicaid budget cuts. Moreover, with more than one third of US counties already being maternity care deserts, cuts to Medicaid will further exacerbate problems with access to maternity care.
Healthy Start: I highlighted the importance of the Healthy Start program last fall. The program was established as a Presidential initiative in 1991 by President George H. W. Bush to support 15 communities with infant mortality rates at least 1.5 times the U.S. national average. By 2024, Healthy Start was funded in 115 communities in 37 states, the District of Columbia, and Puerto Rico. Distinct from other care coordination and home visiting programs, it is the only federal program specifically designed to both engage community and provide services and supports to reduce maternal and infant mortality. Healthy Start sites are reducing infant mortality and improving access to care. The most recent data (2021) show program performance above the national average for key measures, among participants: 85% received early prenatal care compared to 78% for all US pregnant mothers, and 93% received well-child visits compared to an average of 56% for infants and toddlers enrolled in Medicaid that year.
While President Trump’s FY26 budget proposed to cut all Healthy Start funding, the Senate Committee on Appropriations has affirmed the importance of the program. On July 31, 2025 the Senate Committee on Appropriations approved the Labor, Health, and Human Services, and Education, and Related Agencies Appropriations Act, which sets their mark for FY26 funding. For Healthy Start, the Senate LHHS appropriations bill includes the following language: “The Committee provides $145,250,000 for Healthy Start. The primary purpose of Healthy Start is to reduce infant mortality and generally improve maternal and infant health in at-risk communities. Grants are awarded to State and local health departments and nonprofit organizations to conduct and develop a package of innovative health and social services for pregnant women and infants and evaluate these efforts.”
On September 5, 2025, the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies approved its FY26 bill. They approved $223 million to supplement program support funding provided under the headings: ‘‘Primary Health Care’’, ‘‘Health Workforce’’, ‘‘Maternal and Child Health’’, ‘‘Ryan White HIV/AIDS Program’’, ‘‘Health Systems’’, and ‘‘Rural Health’’. No specific mention is made of Healthy Start.
MCH Data: Our team of authors also discussed the role of specialized MCH data systems at the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration’s Maternal and Child Health Bureau (MCHB). Having these data systems in nearly every state has resulted in greater capacity to identify and avoid preventable deaths.
The Senate LHHS appropriations bill includes $113.5 million—a $3 million increase—for CDC’s Safe Motherhood and Infant Health portfolio. In Senate report language, CDC is directed to maintain the same level of staff in the Safe Motherhood Office as were in place on March 31, 2025. The Committee also encourages CDC to use the funding increase to expand support for Maternal Mortality Review Committees [MMRCs], Perinatal Quality Collaboratives [PQCs], and other programs, as well as funding to continue data collection under the Pregnancy Risk Assessment Monitoring System [PRAMS].
The House Labor-HHS appropriations FY26 bill does not mention these CDC programs. It does provide $208 million for CDC work on birth defects, developmental disabilities, disabilities and health.
For MCHB, the Senate LHHS bill provides $799.7 million for the MCH Block Grant and $196 million for Special Projects of Regional and National Significance (SPRANS). Within SPRANS, the bill provides $55 million forState Maternal Health Innovation Grants to improve maternal health outcomes and address disparities in maternal health. It also includes $17 million to support continued implementation of the Alliance for Innovation on Maternal Health (AIM) program in all states, the District of Columbia, territories, and tribal entities to support capacity building, address maternity care deserts, and provide technical assistance nationwide.
The House Labor-HHS appropriations bill includes $985.4 million for Title V MCH, with no more than $163.6 million for SPRANS and $10.2 million for Community Integrated Service Systems (CISS) projects. No further details were provided.
Where do things stand today? While the Senate LHHS bill maintains funding levels for key maternal and infant health programs and initiative, the final Congressional decisions on appropriations to protect maternal and infant health are yet to come. Continued funding is vital. The SACIM/ACIMM authors conclude: “We know that reducing the overall rates at which mothers and infants die each year in the United States, and eliminating inequities in survival, are possible only when a strategic combination of essential, evidence-based policies and programs is adequately funded.”
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