No official summary available for this bill.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6242 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 6242
To amend title XXVII of the Public Health Service Act to provide for a
special enrollment period for pregnant women, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 20, 2025
Mrs. Watson Coleman (for herself, Ms. Clarke of New York, Mr. Carson,
Ms. Dean of Pennsylvania, Mr. Evans of Pennsylvania, Mr. Fields, Ms.
Lois Frankel of Florida, Mr. Gottheimer, Ms. Norton, Mr. Jackson of
Illinois, Mrs. McIver, Mr. Moulton, Mr. Pocan, Ms. Sewell, Ms.
Stansbury, Ms. Tlaib, Ms. Wilson of Florida, Mr. Thanedar, and Mr.
Swalwell) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and Workforce, and Oversight and Government
Reform, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to provide for a
special enrollment period for pregnant women, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Healthy Maternity and Obstetric
Medicine Act'' or the ``Healthy MOM Act''.
SEC. 2. FINDINGS; PURPOSE.
(a) Findings.--Congress finds the following:
(1) Pregnancy is a significant life event for millions of
women in the United States each year.
(2) For more than 30 years, our Nation, through the
Medicaid program, has recognized that pregnant women need
immediate access to affordable care, and has allowed women who
meet income-eligibility requirements to enroll in Medicaid
coverage when they become pregnant.
(3) Congress recognized the central importance of maternity
coverage by classifying maternity and newborn care as one of
the ten essential health benefits that must now be covered on
most individual and small group health insurance plans under
section 1302(b)(1) of the Patient Protection and Affordable
Care Act (42 U.S.C. 18022(b)(1)).
(4) Congress has also recognized the significant challenge
of maternal mortality and the need to eliminate disparities in
maternal health outcomes for pregnancy-related and pregnancy-
associated deaths, and to improve health outcomes for both
mothers and babies through passage of the Preventing Maternal
Deaths Act of 2018 (Public Law 115-344).
(5) Access to comprehensive maternity coverage allows women
to access important pregnancy-related care, which is
demonstrated to improve health outcomes for women and newborns
and reduce financial costs for both consumers and insurers.
(6) Uninsured women, women with grandfathered and
transitional health plans, self-funded student health plans,
and catastrophic and high-deductible health plans may lack
access to comprehensive and affordable maternity coverage.
(7) Employer health plans that exclude dependent daughters
from maternity coverage leave young women without coverage for
their pregnancy, even though Federal law has long held that
treating pregnancy differently than other conditions is sex-
based discrimination.
(8) A special enrollment period is especially important for
young adults, who are at high risk for unintended pregnancies,
yet young adults are frequently enrolled in catastrophic
coverage, which often has fewer benefits, more restrictions,
and higher deductibles.
(9) This coverage would be an equalizer for communities of
color. The maternal mortality rate varies drastically by race
and ethnicity, and where a woman lives. The rising maternal
mortality rate in the United States is driven predominantly by
the disproportionately high African-American maternal mortality
rate, which is four times more than the rate for White women.
(10) According to the Centers for Disease Control and
Prevention, about 700 women die each year in the United States
from pregnancy-related complications. Black and American
Indian/Alaska Native women are about three times more likely to
die from a pregnancy-related cause than White women.
(11) Data demonstrates that 3 in 5 pregnancy related deaths
could be prevented. Improving access to care is one way to help
prevent deaths, regardless of race or ethnicity.
(12) Timely maternity care improves the health of pregnant
women, as well as birth outcomes and the health of babies
throughout their lifetimes. Pregnancy-related maternal
mortality is three to four times higher among women who receive
no maternity care compared to women who do. Regular maternity
care can detect or mitigate serious pregnancy-related health
complications, including preeclampsia, placental abruption,
complications from diabetes, complications from heart disease,
and Graves' disease, all of which can result in morbidity or
mortality for the mother or newborn.
(13) The Centers for Disease Control and Prevention reports
that more than half of all maternal deaths occur at delivery or
in the first postpartum year, whereas just more than one-third
of pregnancy-related or pregnancy-associated deaths occur while
a person is still pregnant. Yet, for women eligible for the
Medicaid program on the basis of pregnancy, such Medicaid
coverage lapses at the end of the month on which the 60th
postpartum day lands.
(14) Timely maternity care and adequate postpartum care can
reduce short- and long-term health care costs. If a woman does
not have access to affordable maternity care during her
pregnancy, and she or her newborn experiences pregnancy
complications that result in health problems after birth, their
insurer may end up paying much higher costs than if the insurer
had covered the woman's maternity care during her pregnancy.
Intensive maternity care can reduce hospital and neonatal
intensive care unit admissions among infants, resulting in cost
savings of $1,768 to $5,560 per birth. For women with high-risk
pregnancies, intensive maternity care saves $1.37 for every $1
invested in maternity care.
(b) Purpose.--The purpose of this Act is to protect the health of
women and newborns by ensuring that all women eligible for coverage
through the Exchanges established under title I of the Patient
Protection and Affordable Care Act (Public Law 111-148) and women
eligible for other individual or group health plan coverage can access
affordable health coverage during their pregnancy.
SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD FOR PREGNANT
INDIVIDUALS.
(a) Public Health Service Act.--Section 2702(b)(2) of the Public
Health Service Act (42 U.S.C. 300gg-1(b)(2)) is amended by inserting
``, including a special enrollment period for pregnant individuals,
beginning on the date on which the pregnancy is reported to the health
insurance issuer'' before the period at the end.
(b) Patient Protection and Affordable Care Act.--Section 1311(c)(6)
of the Patient Protection and Affordable Care Act (42 U.S.C.
18031(c)(6)) is amended--
(1) in subparagraph (C), by striking ``and'' at the end;
(2) by redesignating subparagraph (D) as subparagraph (E);
and
(3) by inserting after subparagraph (C) the following new
subparagraph:
``(D) a special enrollment period for pregnant
individuals, beginning on the date on which such
pregnancy is reported to the Exchange; and''.
(c) Special Enrollment Periods.--
(1) Internal revenue code.--Section 9801(f) of the Internal
Revenue Code of 1986 (26 U.S.C. 9801(f)) is amended by adding
at the end the following new paragraph:
``(4) For pregnant individuals.--
``(A) A group health plan shall permit an employee
who is eligible, but not enrolled, for coverage under
the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not
enrolled, for coverage under such terms) to enroll for
coverage under the terms of the plan upon pregnancy,
with the special enrollment period beginning on the
date on which the pregnancy is reported to the group
health plan or the pregnancy is confirmed by a health
care provider.
``(B) The Secretary shall promulgate regulations
with respect to the special enrollment period under
subparagraph (A), including establishing a time period
for pregnant individuals to enroll in coverage and
effective date of such coverage.''.
(2) ERISA.--Section 701(f) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
adding at the end the following:
``(4) For pregnant individuals.--
``(A) A group health plan or health insurance
issuer in connection with a group health plan shall
permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a
dependent of such an employee if the dependent is
eligible, but not enrolled, for coverage under such
terms) to enroll for coverage under the terms of the
plan upon pregnancy, with the special enrollment period
beginning on the date on which the pregnancy is
reported to the group health plan or health insurance
issuer or the pregnancy is confirmed by a health care
provider.
``(B) The Secretary shall promulgate regulations
with respect to the special enrollment period under
subparagraph (A), including establishing a time period
for pregnant individuals to enroll in coverage and
effective date of such coverage.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.
SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT CHILDREN.
(a) Public Health Service Act.--Section 2799A-7 of the Public
Health Service Act (42 U.S.C. 300gg-117) is amended by adding at the
end the following new subsection:
``(d) Coverage of Maternity Care.--A group health plan, or health
insurance issuer offering group or individual health insurance
coverage, that provides coverage for dependents shall ensure that such
plan or coverage includes coverage for maternity care associated with
pregnancy, childbirth, and postpartum care for all participants,
beneficiaries, and enrollees, including dependents, including coverage
of labor and delivery. Such coverage shall be provided to all pregnant
dependents regardless of age.''.
(b) ERISA.--Section 722 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185k) is amended by adding at the end the
following new subsection:
``(d) Coverage of Maternity Care.--A group health plan, or health
insurance issuer offering group health insurance coverage, that
provides coverage for dependents shall ensure that such plan or
coverage includes coverage for maternity care associated with
pregnancy, childbirth, and postpartum care for all participants,
beneficiaries, and enrollees, including dependents, including coverage
of labor and delivery. Such coverage shall be provided to all pregnant
dependents regardless of age.''.
(c) Internal Revenue Code.--Section 9822 of the Internal Revenue
Code of 1986 is amended by adding at the end the following new
subsection:
``(d) Coverage of Maternity Care.--A group health plan that
provides coverage for dependents shall ensure that such plan includes
coverage for maternity care associated with pregnancy, childbirth, and
postpartum care for all participants and beneficiaries, including
dependents, including coverage of labor and delivery. Such coverage
shall be provided to all pregnant dependents regardless of age.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.
SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.
(a) Coverage of Pregnancy.--
(1) In general.--The Director of the Office of Personnel
Management shall issue such regulations as are necessary to
ensure that pregnancy is considered a change in family status
and a qualifying life event for an individual who is eligible
to enroll, but is not enrolled, in a health benefit plan under
chapter 89 title 5, United States Code.
(2) Effective date.--The requirement in paragraph (1) shall
apply with respect to any contract entered into under section
8902 of such title beginning 12 months after the date of
enactment of this Act.
(b) Designating Certain FEHBP-Related Services as Excepted Services
Under the Anti-Deficiency Act.--
(1) In general.--Section 8905 of title 5, United States
Code, is amended by adding at the end the following:
``(j) Any services by an officer or employee under this chapter
relating to enrolling individuals in a health benefits plan under this
chapter, or changing the enrollment of an individual already so
enrolled due to an event described in section 5(a)(1) of the Healthy
MOM Act, shall be deemed, for purposes of section 1342 of title 31,
services for emergencies involving the safety of human life or the
protection of property.''.
(2) Application.--The amendment made by paragraph (1) shall
apply to any lapse in appropriations beginning on or after the
date of enactment of this Act.
SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR
PREGNANT INDIVIDUALS AND INFANTS.
Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C.
1396a(l)(2)(A)) is amended--
(1) in clause (i), by striking ``and not more than 185
percent'';
(2) in clause (ii)--
(A) in subclause (I), by striking ``and'' after the
comma;
(B) in subclause (II), by striking the period at
the end and inserting ``, and''; and
(C) by adding at the end the following:
``(III) January 1, 2027, is the percentage provided under
clause (v).''; and
(3) by adding at the end the following new clause:
``(v) The percentage provided under clause (ii) for medical
assistance provided on or after January 1, 2027, with respect to
individuals described in subparagraph (A) or (B) of paragraph (1) shall
not be less than--
``(I) the percentage specified for such individuals by the
State in an amendment to its State plan (whether approved or
not) as of January 1, 2025; or
``(II) if no such percentage is specified as of January 1,
2025, the percentage established for such individuals under the
State's authorizing legislation or provided for under the
State's appropriations as of that date.''.
SEC. 7. REQUIRING AND MAKING PERMANENT 12-MONTH CONTINUOUS COVERAGE FOR
PREGNANT AND POSTPARTUM INDIVIDUALS UNDER MEDICAID AND
CHIP.
(a) Medicaid.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)--
(A) in paragraph (88)(B)(iii), by striking ``and''
at the end;
(B) in paragraph (89), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after paragraph (89) the following
new paragraph:
``(90) provide that the State plan is in compliance with
subsection (e)(16).''; and
(2) in subsection (e)(16)--
(A) in subparagraph (A), by striking ``At the
option of the State, the State plan (or waiver of such
State plan) may provide'' and inserting ``A State plan
(or waiver of such State plan) shall provide'';
(B) in subparagraph (B), in the matter preceding
clause (i), by striking ``by a State making an election
under this paragraph'' and inserting ``under a State
plan (or a waiver of such State plan)''; and
(C) by striking subparagraph (C).
(b) CHIP.--
(1) In general.--Section 2107(e)(1)(K) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)(K)) is amended to read as
follows:
``(K) Paragraphs (5) and (16) of section 1902(e)
(relating to the requirement to provide medical
assistance under the State plan or waiver consisting of
full benefits during pregnancy and throughout the 12-
month postpartum period under title XIX) such that the
provision of assistance under the State child health
plan or waiver for targeted low-income children or
targeted low-income pregnant women during pregnancy and
the 12-month postpartum period shall be required and
shall include coverage of all items or services
provided to a targeted low-income child or targeted
low-income pregnant woman (as applicable) under the
State child health plan or waiver.''.
(2) Conforming.--Section 2112(d)(2)(A) of the Social
Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by striking
``the month in which the 60-day period'' and all that follows
through ``pursuant to section 2107(e)(1),''.
(c) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to services
furnished on or after the date that is 1 year after the date of
the enactment of this Act.
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) or a State child health plan under title
XXI of such Act (42 U.S.C. 1397ee et seq.) that the Secretary
of Health and Human Services determines requires State
legislation in order for the plan to meet any requirement
imposed by amendments made by this section, the respective plan
shall not be regarded as failing to comply with the
requirements of such title solely on the basis of its failure
to meet such an additional requirement before the first day of
the first calendar quarter beginning after the close of the
first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
SEC. 8. RELATIONSHIP TO OTHER LAWS.
Nothing in this Act (or an amendment made by this Act) shall be
construed to invalidate or limit the remedies, rights, and procedures
of any Federal law or the law of any State or political subdivision of
any State or jurisdiction that provides greater or equal protection for
enrollees in a group health plan or group or individual health
insurance offered by a health insurance issuer.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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