Maryland is slightly ahead of most states when it comes to supporting maternal mental health, but other states have been gaining ground in the last year while Maryland has been static, according to an analysis that assesses states on a A-F grading scale.

The 2025 Maternal Mental Health State Report Card , released Thursday, gave Maryland a ‘C’ this year, pushing the state just ahead of the national average score of a C-.

But health advocates note that 26 other states boosted their “grades” over last year’s report card, and say Maryland needs to increase mental health screening efforts to help improve its score for next year’s report card.

“Maryland has a lot to be proud of in terms of its grade. It is performing better than most states on maternal mental health policies,” said Caitlin Murphy, one of the researchers who worked on the report. “Maryland is doing better than the national average, which is great … There’s a few key areas where Maryland could continue to improve.”

The Policy Center for Maternal Mental Health released its third annual report Thursday to update grades on states’ accessibility to maternal mental health services.

“The good news is that the U.S. national grade has improved slightly from a D+ to a C- … We’re also seeing 26 state grades improving this year alone, with five state’s earning B’s,” Murphy said. “We know there’s still a lot more work to be done on 19 states that are still earning D or F grades.”

This year, five states received B grades, 27 states received C grades, 17 states received D grades and 2 states received F’s. That’s an improvement from last year, when 24 states received D grades and 5 states receiving failing grades.

“Folks are realizing just how crucial it is to address this. And not only to destigmatize maternal mental health, but really put the policies in place at the state level and the health insurance level to get … all the things we know are needed to support mental health for moms,” Murphy said.

“Folks are very aware of postpartum depression, but this also includes postpartum anxiety, OCD (obsessive-compulsive disorder), psychosis – which is much rarer. But, there is starting to be more understanding around that,” she said.

The report focuses on several areas where states can improve maternal mental health access to services and health care coverage across the states. Some metrics considered include Medicaid coverage, access to maternal mental health providers, and data from insurance coverage and claims for services.

One category assesses whether Medicaid requires screenings and data collection for mental health concerns such as prenatal depression and post-partum depression. Last year’s report card docked Maryland over not requiring data collection on mental health screening – an area that Maryland lost points on again this year.

“States can require their health plans to report on rates of maternal mental health screening,” Murphy said. “Right now, Maryland does not require its health plans, and in particular its Medicaid health plans, to report on rates of maternal mental health screening.”

Dan Martin, senior director of public policy for the Mental Health Association of Maryland, said that the report card shows “that there is room to improve in Maryland,” including in screening for maternal mental health needs.

“Screening and identification for perinatal mood and anxiety disorders really improves the likelihood for recovery of the mother. It supports healthy childhood development,” he said. “It (maternal mental health) can have profound impacts on the health of the mother and her infant and her family.”

That doesn’t mean that those screenings are not happening, Murphy noted, just that the state doesn’t require collection of that data, which can make tracking statewide progress difficult.

“The more health plans that are reporting out the screening rates, the better idea we’re able to have of if it’s actually happening – and that’s one of the biggest gaps right now in terms of data,” she said. “We don’t know yet if maternal mental health disorders are reducing, and part of that is the need for screening to be more universal and for screening to be required, so we can actually track this over time.”

The policy center added new metrics this year that measured whether states invested in group prenatal care for the Medicaid populations. Murphy said such programs help connect pregnant people and new mothers to peers and social supports.

Maryland earned a few extra points for programs such as the Medicaid CenteringPregnancy Program, which brings people with a similar due date together to will learn about what to expect during pregnancy as a community.

But it was not enough to boost the state’s grade to a C+, Murphy said.

She noted that Maryland is ahead of other states when it comes to health care coverage for pregnancy through Medicaid, the joint federal-state health insurance program targeted for lower-income families and other specific populations.

But with members of Congress deliberating significant cuts to Medicaid, Murphy worries that states will backslide on progress made over the last few years.

“Even though states are making this incremental progress on maternal mental health, we also know that right now Congress is putting forward proposed policies to cut Medicaid and Health and Human Services programs,” she said. “If those kinds of cuts go through, we are going to see state scores and the overall national score backslide.”

KFF, a nonpartisan health research organization, reports that in 2023, 41% of births in the United States were financed by Medicaid. In Maryland, about 42% of births were supported by Medicaid coverage that year.

“That statistic is often surprising to folks, but it reflects the fact that this is a really important source of coverage,” Murphy said.

She said that interest in maternal mental health has been increasing over the last few years and hopes that increased awareness of the issue will help deter Congress from cutting supports for maternal mental health services.

“It’s been wonderful that over the past several years, I think people have started to understand the depths of how important maternal mental health is and also how far we have to go,” Murphy said. “This is a real failure of our health care systems to support our moms and families … It’s really a matter of life or death.”