Maternal Insights for Medicaid

Access to maternity care is becoming more constrained. For Medicaid plans, this increases the importance of identifying pregnant members early, reaching those who may be difficult to engage, and connecting them to available care.

The Maternal Health Challenge

Medicaid finances approximately 41% of U.S. births, making maternal health a significant clinical and financial responsibility for Medicaid plans.

Access is tightening at the same time prenatal care is starting later. CDC data show that first-trimester prenatal care fell from 78.3% of births in 2021 to 75.5% in 2024, while late or no prenatal care increased from 6.3% to 7.3%.²

These gaps also have utilization implications. In a study of 240,597 Medicaid-covered births, 55.1% had at least one emergency department visit during pregnancy.³

For Medicaid plans, the challenge starts before a prenatal visit is ever missed: knowing who is pregnant, reaching them, and connecting them to appropriate care.

• 34.6% of U.S. counties are maternity care deserts. March of Dimes, 2026.
• 96 labor and delivery units closed across 35 states between Jan 2024 and May 2026. March of Dimes, 2026.

The Gaps

1. Identifying and Engaging Pregnant Members

A plan cannot close a prenatal care gap if it does not know a member is pregnant or cannot reach them.

Claims, pharmacy, eligibility and other administrative data can identify members who may be pregnant. But a suspected pregnancy in the data still needs to be confirmed, and the member still needs to be reached.

A pragmatic quality-improvement evaluation of Florence included 30,974 Medicaid members with suspected maternity needs. Among members assigned to AI-assisted SMS outreach, 120 active pregnancies were identified among individuals not previously engaged in prenatal care.

Identify → Engage → Confirm → Connect

2. Connecting Members to Care

Identification is only the first step. NCQA’s Prenatal and Postpartum Care (PPC) measure evaluates timely prenatal care and postpartum follow-up.⁴

Reaching those encounters can depend on factors well outside the clinical visit.

• Scheduling
• Transportation
• Benefits
• Medication access
• Social needs
• Health literacy

Education is part of that process. Members may need help understanding available benefits and resources, preparing for prenatal and postpartum care, or knowing when a concern requires clinical follow-up.

Meet Florence

Clinically Validated, Automated Care Management

Florence extends the care team through clinically validated, goal-oriented conversations.

Clinical protocols guide proactive outreach while AI interprets inbound responses, prioritizes needs, and surfaces actionable insights for the care team.

For Medicaid plans, Florence provides a way to engage and support more members without requiring proportional growth in care-management staffing.

Why Conversational SMS

Traditional Medicaid outreach often relies on mailed materials, outbound telephone calls, or robocalls. These approaches can require repeated attempts and, for calls, the member and caller to be available at the same time.

Conversational SMS gives members a lower-friction way to respond on their own time, without an app, portal, or scheduled call.

Once a member responds, the interaction can move beyond outreach: she can confirm a pregnancy, ask a question, request assistance, or identify a barrier to care.

That creates a practical advantage for care management: the team can work from an active member conversation rather than repeatedly starting with cold outreach.

• 11.7% response among members receiving Florence maternity outreach — 1,421 of 12,101 members
• 18.4% response among Spanish-speaking maternity members, vs. 10.8% among English-speaking members

How Florence Works

Clinically Validated Care Management

1. Validated Clinical Protocols. Guide proactive outreach based on the population and care objective.
2. Two-Way SMS. Members respond with questions, needs and barriers when convenient.
3. AI-Assisted Interpretation. Inbound responses are categorized and routed through predefined workflows.
4. Care-Team Escalation. Members requiring additional support are directed to human follow-up.

Why Clinical Validation Matters

Maternal-health conversations can involve pregnancy status, medications, blood pressure, diabetes, behavioral health and other clinical concerns. The boundaries of automation therefore matter.

Florence uses validated clinical protocols to define what information is requested, how member responses are handled, and when care-team follow-up is needed. AI interprets inbound responses within those workflows rather than independently generating clinical advice.

What this looks like in practice

Medicaid Hypertension Deployment; n = 1,434

• 295 initiated a conversation with Florence
• 206 responded to a Florence request
• 106 used the Knowledge Base outside protocol

• 43 No PCP
• 22 No BP monitoring device
• 23 Housing instability
• 12 Food-access challenges
• 21 Submitted BG readings

The maternal-health application follows the same governed approach: approved education and resources, structured collection of member information, and escalation when human follow-up is needed.

From Outreach to Care

• 325% increase in prenatal visit attendance
• 100% increase in Healthy Rewards participation

In a Medicaid maternal-health deployment, Florence-supported outreach was associated with a 325% increase in prenatal visit attendance among a previously non-utilizing maternity cohort. The same deployment saw a 100% increase in Healthy Rewards participation.

The relevant endpoint is not the number of messages sent or opened. It is whether engagement helps members connect with care and participate in available health-plan programs.

What Members Reveal Once They Engage

Administrative and clinical data can tell a plan a great deal about a member. Conversation can add information that has not yet been captured.

For maternal health, this matters because successful connection to prenatal and postpartum care may depend on needs that are not apparent from a claims record alone.

Pregnancy Is Part of a Longer Care Journey

Pregnancy may be the point at which a member first engages, but the care needs do not end at delivery.

During pregnancy, a member may also be managing hypertension, diabetes, medication needs, benefits questions, or social barriers. After delivery, the mother’s care continues through postpartum and primary care, while the baby’s preventive-care journey begins with well-child visits.

This creates an opportunity to build on the relationship established during pregnancy rather than starting over with a new outreach campaign for each care gap.

• Maternal Care. Prenatal • Postpartum
• Hypertension. Monitoring • Escalation
• Diabetes. Education • Ongoing management
• Member. One ongoing relationship
• Social Needs. Transportation • Food • Housing • Benefits
• Primary Care. Longitudinal connection
• Well-Child Care. Preventive care through early childhood

Extending Engagement Into Preventive Care

Separate Medicaid preventive-care deployments show that the same engagement model can support care after pregnancy, including well-child and adult preventive visits.

• 6.4% increase in well-child visits
• 17.7% increase in annual wellness visits

These results come from separate Medicaid preventive-care deployments; they are included to show that Florence’s engagement model can support recommended care beyond a maternity program.

For a Medicaid plan, that creates continuity across pregnancy, postpartum care, chronic disease, primary care, and pediatric preventive care.

Extending the Care Team

The final operational question is capacity: can a plan engage more members without creating an equivalent increase in manual care-management work? Florence automates routine outreach and organizes initial responses so staff can focus on members who have identified a need or require intervention.

Care-Team Multiplier

In the pragmatic quality-improvement evaluation, care coordinators described Florence as a “front door” to engagement. Rather than repeatedly cold-calling members, coordinators could focus on individuals who had already signaled readiness to engage.

More Members Reached → Responses Interpreted → Needs Prioritized → Care-Team Intervention

Executive Takeaway

Maternal health starts with identifying pregnant members early enough to act. As maternity access becomes more constrained, Medicaid plans need a reliable way to establish contact, understand barriers, and connect members to care.

The evidence in this brief supports a simple operating model: use clinically governed conversational SMS to extend reach, convert member responses into actionable information, and reserve human care-management capacity for the members who need it.

Because the same engagement model can support postpartum, chronic, primary, and pediatric preventive care, the value can extend beyond a single maternity campaign.

• 10+ years of clinical development
• 40M+ patient interactions
• 100+ studies

References

1. March of Dimes. Nowhere to Go: Maternity Care Deserts Across the U.S. 2026.
2. Osterman MJK, Martin JA. Changes in Timing of Prenatal Care Initiation: United States, 2021–2024. NCHS Data Brief No. 550. 2026.
3. Hersh AR, Martinez Acevedo A, Mandelbaum A, et al. Emergency department use during pregnancy by Medicaid type. BMC Pregnancy and Childbirth. 2025.
4. NCQA HEDIS Technical Specifications, Prenatal and Postpartum Care (PPC).
5. Lowentritt JE, Miller J, Hill S, et al. Improving Patient Engagement and Early Pregnancy Identification in Medicaid Through AI-Assisted SMS Outreach: A Pragmatic Quality Improvement Case Study.
6. Generated Health. Florence Medicaid maternal-health, CCHA hypertension, and preventive-care deployment data.

Generated Health Media Contact: janhavi.punyarthi@generatedhealth.com

Florence — The safest way to multiply your care team.

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