How States Are Using the RHTP to Advance Maternal Health

Heather Howard, Jamila McLean, and Rebecca Lopez, State Health and Value Strategies

Rural health distress has emerged as a critical driver of poor maternal health outcomes, reflecting structural barriers in accessing care, worsening workforce shortages, and the broader social drivers of health. Over the past decade, the closure of rural hospitals and obstetric units has forced many pregnant women to travel long distances for prenatal, delivery, and postpartum services, increasing delays in care and the likelihood of unmanaged complications. At the same time, shortages of obstetricians, midwives, and primary care providers limit continuity of care and reduce opportunities for early detection of high-risk conditions such as hypertension, diabetes, and mental health disorders. 

These barriers are compounded by higher rates of poverty and uninsurance and limited transportation infrastructure in many rural communities. As a result, rural residents experience higher rates of maternal morbidity and mortality than their urban counterparts, highlighting how rural health system fragility directly translates into heightened risks during pregnancy and childbirth. 

The Rural Health Transformation Program (RHTP) provides an opportunity for states to leverage federal funding to support investments to improve maternal health outcomes and reduce disparities. State applications paint stark pictures of the gaps in access to maternity care in rural areas and the disparities in health outcomes. To address these challenges, states are proposing efforts to expand and train the perinatal workforce, deploy technology-enabled obstetric services, improve access and care coordination, and enhance prevention and early intervention across the perinatal continuum. This expert perspective highlights select state initiatives and activities that propose leveraging the RHTP to advance maternal health. 

Examples of Proposed State Efforts to Advance Maternal Health

• Alabama identified high maternal mortality as a key focus and included a Maternal and Fetal Health Initiative, which would offer digital maternity care by providing telerobotic ultrasound devices and labor and delivery carts to rural hospitals.
  
  
• Alaska’s Healthy Beginnings initiative seeks to strengthen maternal and child health as a foundation for healthy families with the goal of reducing the urban-rural gap in infant and maternal mortality/morbidity by 50%. The initiative proposes expanding technology-enabled maternal care infrastructure, by investing in remote fetal monitoring devices, coordinated case management systems, and telehealth technology to support high-risk pregnancies. 
  
  
• Arizona’s proposed Improving Rural Maternal-Fetal Health Grant aims to improve maternal and infant health outcomes in rural Arizona by strengthening prevention, early intervention, and coordinated care before, during, and after pregnancy. The program addresses high maternal mortality rates and limited access to maternity services in rural areas by expanding evidence-based maternal health programs, supporting disease prevention efforts such as congenital syphilis screening and treatment, and enhancing training and resources for providers serving rural and tribal communities.
  
  
• California’s RHTP application proposes establishing a network of regional care collaboratives to support rural communities. The program would create regional hub-and-spoke networks anchored by hospital hubs, with spokes including critical access hospitals, clinics, birthing centers, and other providers. Key initiatives include the OB Nest prenatal remote monitoring program and perinatal psychiatry e-Consult resources such as the Perinatal Psychiatry Access Program (PPAP) and the California Child and Adolescent Mental Health Access Portal (Cal-MAP). Additionally, California aims to strengthen the maternal health workforce through Train-the-Trainer programs, expansion of non-physician roles such as community health workers (CHWs), nurses, doulas, and midwives, and the implementation of clinician upskilling programs and family medicine obstetrics fellowships.
  
  
• Connecticut proposes to expand universal nurse home-visits across its rural regions so that new and expecting families receive consistent maternal and newborn support in their homes that fosters long-term health and wellbeing across their lifespan. Additionally, the plan supports the adoption of AI-enabled remote patient monitoring, virtual care platforms, and connected devices to strengthen chronic disease management, behavioral health engagement, and maternal care access in rural and tribal communities.
  
  
• Georgia’s RHTP plan proposes placing obstetric carts with essential medications and supplies for hemorrhage management, neonatal resuscitation, and preeclampsia treatment in rural, non-delivering emergency departments. The state also plans to create patient safety bundles in all 66 birthing hospitals across the state, with an emphasis on the 15 rural hospitals. Additional activities include implementing the Pediatric Psychiatry ECHO model in partnership with pediatric psychiatrists to train rural physicians and advanced practice providers via telehealth on managing complex cases, including medication management and connecting patients to appropriate resources. Georgia also plans to expand the Georgia Department of Public Health’s Perinatal Psychiatry, Education, Access, and Community Engagement (PEACE) for Moms program, which offers provider-to-provider consultations for obstetric clinicians treating pregnant and postpartum patients with mental health and substance-use concerns, including on-demand consultations with a 30-minute response time.
  
  
• Iowa’s RHTP plan includes the EMS Community Care Mobile Initiative, which features three sub-initiatives, including the High-Risk OB and Neonatal Transport Project and Mobile Integrated Health Care (MIH). The plan proposes investing in telehealth-equipped EMS to transport high-risk mothers and newborns to higher levels of care, while MIH teams will integrate prenatal and postpartum care using telehealth to help close maternal health gaps in rural areas. The initiative will also upgrade existing ambulances and helicopters with OB-specific equipment, monitoring devices, and telehealth connectivity to enable specialist-guided care during transport. In addition, EMS clinicians will receive advanced training, including high-fidelity simulation, to better manage complex deliveries and neonatal emergencies.
  
  
• Kentucky’s RHTP funding will support PoWERing Rural Maternal and Infant Health: Community-Based Teams. The initiative is a patient-centered, community-based model designed to expand access to perinatal care and address Kentucky’s maternity deserts. PoWER teams will be coordinated by a centralized telehealth nurse and overseen by a delivery provider throughout prenatal and postpartum care. Teams will comprise CHWs, doulas, and peer support specialists, as needed. The initiative will also work to expand timely access to home visiting services and additional wraparound services such as WIC and the KY Moms Maternal Assistance Toward Recovery program. Kentucky will also fund the creation of a perinatal CHW certification program through the Kentucky Office of Community Health Workers to build a pipeline of professionals trained to serve rural maternal health PoWER teams.
  
  
• New Mexico’s RHTP plan includes the Healthy Horizons initiative, which aims to expand access to specialty care and chronic disease management in rural communities through expanded care networks, evidence-based prevention programs, innovative care models, and enhanced technology, with a particular focus on maternal health and other high-burden conditions. Key activities include developing incentive payment models for rural hospitals and clinics that establish and sustain specialty and maternal care service lines, providing clinical training and targeted technical assistance to support these services, and delivering provider training to integrate perinatal mental health screening, referral, and treatment into maternal care workflows. The initiative will also support school-based health programs that offer early screening for chronic conditions, behavioral health interventions, and telehealth triage for maternal and pediatric needs.
  
  
• New York’s RHTP plan proposes expanding the Rural Roots: Building a Sustainable Rural Health care Workforce (Rural Roots) initiative. This is NY’s signature workforce development model, and a comprehensive strategy to recruit and train more practitioners for rural areas by combining planning, targeted education, and innovative support. To address maternal care deserts in rural communities, Rural Roots will offer advanced training in pregnancy support, lactation counseling, and simulation-based obstetrics training for EMTs, nursing, and medical students.
  
  
• Ohio’s RHTP plan proposes addressing maternity deserts through legislative changes and targeted support for rural hospitals to establish quality, low-cost birthing centers operated by general practitioners and midwives for mothers with low-risk pregnancies. The proposal also emphasizes leveraging telehealth to expand access to maternal and infant health services, including nurse home visits, doula support, group prenatal care, lactation consultation, and pregnancy risk assessments. Additionally, RHTP funds will support training and upskilling for nurses to deliver evidence-based home visiting models.
  
  
• South Dakota will use RHTP funding to establish Regional Maternal and Infant Health Hubs. Initial activities will include conducting a maternal health gap, policy, and funding analysis to identify service shortages, regulatory and payment barriers, and workforce needs, as well as a landscape analysis of social services, home visiting programs, and community-based supports for mothers and infants. The state will then design and launch regional maternal health hubs linked to local “spoke” sites, using a hybrid OB-Nest–style model that combines in-person care, telehealth, and remote monitoring for prenatal and postpartum services. Additional activities include funding and supporting community and tribal organizations to develop and sustain doula programs and integrating social and clinical care by establishing and testing a patient navigation model to address nonmedical barriers affecting maternal and infant health outcomes.
  
  
• Virginia’s RHTP initiative, Innovative Maternal Care, will provide grants to collaboratives of maternal and family medicine practices, community-based organizations, and health systems to support a range of prenatal, labor and delivery, and postpartum services in rural communities. The initiative will connect pregnant and postpartum women with community maternal health hubs and mobile units that provide pre- and postnatal care, education, support, and resource navigation. Funding will also support technology for remote patient monitoring and telepresence capabilities for high-risk births, enabling tele-consults with off-site specialists.