The Mississippi State Department of Health is overhauling its home visitation and care management program for high-risk pregnant women and infants in an effort to move the needle on the state’s high infant mortality rate.

The Healthy Moms, Healthy Babies program, which previously served mothers and babies in all 82 counties, will restart under a pilot model to serve 10 counties with few resources and utilize community health workers for home visitation rather than nurses, State Health Officer Dr. Dan Edney told Mississippi Today. 

The Mississippi State Department of Health has not publicly announced the redesigned program or named the 10 counties that will be targeted, though it stopped accepting new patients and referrals in January, according to the agency’s website. 

The 10 counties will be selected based on maternal and infant health data, service gaps and capacity to support intensive case management, and the agency will announce the selected counties once implementation planning is complete, health department spokesperson Greg Flynn said. 

Edney said the changes were implemented because while the program was serving moms and babies “wonderfully,” it was failing to reduce infant and maternal mortality, which — already at one of the highest rates in the nation — reached a 10-year high in 2024. 

“I couldn’t justify continuing to spend and it not improving the outcomes,” Edney said. “So, the whole model redesign is more about improving outcomes and attacking the highest impacted counties that right now, no one is serving.” 

Edney also pointed to the program’s high cost and noted that it has been affected by changes in Medicaid payments for high-risk prenatal services.

Healthy Moms, Healthy Babies serves high-risk mothers and infants by providing home visits, health education and referrals to wraparound services and benefits, including mental health, transportation, health insurance, breastfeeding, employment and food assistance during and after pregnancy. Mothers qualify if they meet certain criteria, including chronic illness, substance use, unsafe living conditions or teen pregnancy. Infants may qualify if they were born prematurely, underweight or with medical complications. 

The new model will use a team-based approach, with registered nurses administering clinical oversight and health education, licensed social workers establishing connections to resources and community health workers providing regular support to participants. There will be twice as many community health workers compared to other disciplines to increase enrollment and community support, Flynn said. 

In August, the Mississippi State Department of Health declared a public health emergency in response to the state’s rising infant mortality rate. In 2024, the state’s infant mortality rate was near twice the national average, and 323 infants died before their first birthday.

Black families are disproportionately affected by the crisis. According to the health department’s review of 2023 and 2024 data, Black infants are three times more likely to die than white infants. In 2024, when Mississippi’s infant mortality rate reached a 10-year high, white infants experienced their lowest mortality rate in a decade. 

Strengthening the Healthy Moms, Healthy Babies program was one of the agency’s key measures in its multi-pronged response to the crisis, according to its emergency declaration announcement. 

Home visiting is one of the most effective strategies for improving maternal and infant health, and community health worker models have been shown to have strong outcomes, said Honour McDaniel Hill, the director of Infant and Maternal Health Initiatives for March of Dimes. 

“They meet families where they are,” Hill said. “They’re going where families need care and they’re doing it through this trusted, community-based support.” 

Home visitation programs led by community health workers, in partnership with nurses and social workers, were linked to a lower risk of adverse birth outcomes and helped to reduce racial disparities, according to a 2023 study published in JAMA Pediatrics. 

Last year, Healthy Moms, Healthy Babies served 810 infants and mothers from nearly every county in the state, according to health department data. Since 2021, the program has worked with more than 4,500 participants.

Edney said the program’s new model aims to serve the same number of participants but focus on a smaller geographic area. 

Participants in areas that are no longer covered by the program will be referred to alternative home visitation services, such as Healthy Start and Medicaid services, Flynn said. 

He said the health department is also strengthening partnerships, referral pathways and education for community organizations and providers to ensure that pregnant and parenting families can access care anywhere in the state.

“Everybody’s still going to be served, we’re just going to focus on the areas that were unserved, and do them better,” Edney said. 

Nakeitra Burse is the founder and executive director of Six Dimensions, a Ridgeland-based nonprofit focused on improving Black maternal health outcomes, and a member of the state’s Maternal Mortality Review Committee. She said she appreciates the health department’s effort to focus scarce resources on communities with the greatest need, but is concerned about the burden the change could place on community-based organizations. 

“I want us that work at the community level to be able to figure out how to adjust for what may be to come if there’s an overflow” of patients in need of services, Burse said.  

Delta Health Center, a federally-qualified community health center with locations throughout the Mississippi Delta, operates a separate but similar home visitation program led by community health workers. 

Robin Boyles, the organization’s chief program planning and development officer, said the program has significantly reduced patients’ adverse birth outcomes. Between 2023 and 2024, the rate of low birth weight babies fell from 15% to 6%, while preterm deliveries dropped from 13% to 3% from 2023 to 2024. She said the organization welcomes program referrals.

The new model is expected to reduce the cost of the Healthy Moms, Healthy Babies program, which previously cost the health department $4 million a year — a cost the agency could not continue to sustain, Edney said. 

“Healthy Moms is impossible to do statewide,” he said. “We just don’t have the resources.”

Edney said the Healthy Moms, Healthy Babies program was previously funded with a combination of Medicaid revenue and discretionary funds from the health department. Now, he said, Mississippi Medicaid is transferring the primary financial responsibility for high-risk prenatal care to managed care organizations, the private companies that provide services to more than half of Medicaid beneficiaries, a change the agency has been considering for the past year. 

Division of Medicaid spokesperson Matt Westerfield did not respond to several requests for comment from Mississippi Today about changes to Medicaid reimbursements for high-risk prenatal care. Flynn declined to provide additional details about when or why the policy change was made and directed Mississippi Today’s questions to the Division of Medicaid.

Flynn said that while cost savings are important, the primary goal of the program’s redesign is to improve efficacy, accountability and measurable improvements in pregnancy and birth outcomes. 

“I’ll be really disappointed if we don’t move the needle in those 10 counties,” Edney said.