Shared Labor—Public Private Partnerships for Maternal Health Equity

Abstract The United States faces a worsening maternal health crisis, with mortality rates far exceeding those of peer nations and persistent inequities for Black, Indigenous, and rural women. Medicaid finances over 40% of U.S. births, yet fiscal pressure, heightened scrutiny of program spending, and political resistance to benefit expansion constrain states’ ability to adopt new maternal health interventions. In this environment, outcome-indexed public–private partnerships (PPPs) offer a pragmatic pathway to advance maternal health equity while tying expenditures to measurable value. This paper examines the promise and limitations of emerging FemTech innovations such as virtual doula care, remote patient monitoring, and AI-enabled risk assessment—and the structural barriers that impede their adoption in Medicaid. We argue that innovation failures reflect misaligned incentives rather than lack of technological potential. To address this gap, we propose a coordinated policy framework that aligns the Advanced Research Projects Agency for Health (ARPA-H), the Centers for Medicare & Medicaid Services (CMS) Transforming Maternal Health Model, and Medicaid Section 1115 waivers across the innovation lifecycle. This approach enables disciplined experimentation, independent evaluation, and scalable deployment of equity-focused technologies within Medicaid, safeguarding maternal health gains under constrained fiscal conditions.