To promote prenatal health and improve birth outcomes, the Centers for Medicare and Medicaid Services (CMS) developed the Strong Start for Mothers and Newborns initiative. The Strong Start initiative is assessing several enhanced prenatal care approaches, including home visiting. As part of the Strong Start initiative, CMS, in partnership with the Administration for Children and Families and the Health Resources and Services Administration, established the Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start). MIHOPE-Strong Start is evaluating the effectiveness of evidence-based home visiting for improving prenatal care and birth outcomes among women enrolled in Medicaid or the Children's Health Insurance Program. This report presents findings from a qualitative substudy of MIHOPE-Strong Start designed to summarize state efforts to promote prenatal health and improve birth outcomes, including but not limited to home visiting.