Maternal morbidity is a critical health challenge in the United States. Severe obstetric complications (SOCs) are a subset of maternal morbidity representing the most clinically serious events occurring at or around delivery and carry significant consequences for mothers, infants, and payers alike. SOCs include events such as blood transfusion, sepsis, eclampsia, and acute respiratory distress syndrome (ARDS) that threaten lives, extend hospitalizations, and drive long-term health consequences for mothers and children.

Milliman was commissioned by the Episcopal Health Foundation and the Michael & Susan Dell Foundation to estimate the prevalence and healthcare costs associated with SOCs among Texas Medicaid STAR beneficiaries, with a specific focus on statewide experience and the North Texas region, defined for this analysis as Dallas and Tarrant counties. Both foundations are providing support to the North Texas Maternal Health Accelerator, a program focused on Dallas and Tarrant counties that is working to prevent SOCs among the Medicaid beneficiaries that they serve. Medicaid bears a disproportionate share of the financial burden of SOCs, covering 41.5% of births nationally and 47.8% of births in Texas as of 2023. By 2025, the share of births covered by Medicaid in Texas had risen to 53%.

For this report, Milliman applied the complication definitions used by partners in the Maternal Health Accelerator, which identify SOCs during the delivery admission and through 60 days post-delivery. The analysis also evaluates severe preeclampsia and hypertensive readmissions, which are not classified as SOCs in all measurement frameworks but are clinically important maternal health events.