Analysis of Federal Bills to Strengthen Maternal Health Care

In the United States, approximately 700 women die each year as a result of pregnancy or delivery complications. An additional 50,000 women each year face short or long-term severe consequences to their health as an outcome of pregnancy or labor. Both maternal mortality and severe morbidity have been steadily increasing over the past years, prompting a federal response to maternal health issues. There has been growing attention to wide racial and ethnic disparities in maternal health outcomes as well as gaps in maternity care services in many communities, particularly rural areas.  There has also been growing emphasis on improving care in the postpartum period, such as recommendations to expand care beyond the traditional one postpartum visit.

Medicaid pays for more than four in ten births nationally and is the focus of some of the pending bills in Congress as well as some state efforts to improve maternity care. Federal law requires that all states extend Medicaid eligibility to pregnant women with incomes up to 138% of the federal poverty level ($29,435 annually for a family of three).  Pregnancy-related coverage for the woman must last through 60 days postpartum. In the states that have expanded eligibility for Medicaid under the Affordable Care Act (ACA), many low-income women can remain on Medicaid after the 60 days postpartum period or qualify for federal subsidies to purchase coverage through ACA Marketplace plans. However, in the states that have not adopted the ACA’s Medicaid expansion, postpartum women need to requalify for Medicaid as parents to stay on the program, but eligibility levels for parents are much lower than for pregnant women. As a result, many women in non-expansion states become uninsured after pregnancy-related coverage ends 60 days postpartum because, even though they are poor, their income is still too high to qualify for Medicaid as parents.

The 115th Congress passed the Preventing Maternal Deaths Act of 2018 (H.R. 1318), which authorized the CDC to increase support for state and tribal maternal mortality review committees (MMRCs). A number of other bills, focusing on maternal health, have been introduced in the Congress in the 2019-2020 session. These pending bills address a number of related maternity care issues, including extending Medicaid postpartum coverage from 60 days to one year, funding for clinical training on health equity and implicit bias, developing broader networks of maternity care providers in rural areas, and research on the potential benefits of Medicaid coverage for doula care. Below, are summaries of several bills on maternal health currently pending in Congress.

Proposed Federal Legislation Regarding Maternal Health Care and Coverage, as of January 24, 2020
Bill Sponsors Status  Focus Areas Description
H.R. 4996, Helping Medicaid Offer Maternity Services (MOMS) Act of 2019 Rep. Robin Kelly (D-IL)

24 Cosponsors
(16 Democrats, 8 Republicans)

Approved by House Energy and Commerce Committee on 11/20/2019, and ordered to be reported to the whole House chamber. — Extending Medicaid postpartum coverage

— Research on Medicaid coverage of Doula care

Goal: to provide a State option under the Medicaid program to provide and extend coverage for pregnant and postpartum individuals through one year postpartum.

  • Amends Title XIX and Title XXI of the Social Security Act to allow State option to extend continuous coverage, with full benefits under Medicaid or CHIP, for individuals who are or become pregnant, changing the 60-day postpartum coverage window to a 1-year period.
  • Increases Medicaid’s Federal Medical Assistance Percentages (FMAP) by 5% for the first year that –a state elects to provide continuous Medicaid coverage for up to 1 year postpartum.
  • Mandates the Medicaid and CHIP Payment and Access Commission (MACPAC) to produce a report on coverage of doula care under State Medicaid programs.
H.R. 4995, Maternal Health Quality Improvement Act of 2019

 

 

Rep Elliot Engel (D-NY)

25 Cosponsors
(16 Democrats, 9 Republicans)

Approved by House Energy and Commerce Committee on 11/19/2019, and ordered to be reported to the whole House chamber. — Supporting training for clinicians on implicit bias and  health equity

— Broadening obstetric workforce in rural communities

— Funding for states to enhance data collection and strengthen perinatal quality collaboratives

Goal: to improve obstetric care and maternal health outcomes in rural areas, provide rural obstetric network grants and telehealth network grants, and authorize funding for innovation from and training for healthcare providers.

  • Amends Public Health Service Act (PHSA) to direct the Secretary of HHS and the CDC to expand, intensify, and coordinate activities with respect to maternal mortality and morbidity.
  • Authorizes $3,000,000/year for FY 2020-2024 for grants to identify and develop successful delivery models for maternal and obstetric care in rural areas, collaboration between health facilities that have obstetric care units and those who do not, training on obstetric care for hospitals without obstetric units, research on racial/ethnic inequities in birth outcomes among rural residents.
  • Requires Office of Research on Women’s Health to identify and prioritize multidisciplinary research on maternal mortality and other maternal morbidity outcomes, as well as other reproductive health issues, including menopause.
  • Authorizes $5,000,000/year for FY 2020-2024 for grants supporting training on maternal mental health, maternal substance use disorder, social determinants of health that impact individuals living in rural communities, and implicit bias for physicians, medical residents, nurse practitioners, physician assistants, nurse midwives, and other health professionals who provide obstetric care in rural areas.
  • Authorizes $5,000,000 for each of FY 2020-2024 for grants to accredited schools of medicine, nursing, and other health professional training programs.
  • Requires the Government Accountability Office (GAO) to prepare a report on data that may identify potential workforce gaps in maternal or obstetric clinicians, health professionals, and facilities.
  • Authorizes $10,000,000/year for FY 2020-2024 for the Secretary of HHS to award grants to identify, develop, or disseminate best practices to improve maternal health quality and outcomes among community health centers.
  • Requires the Secretary of HHS to contract with an independent research organization to study training to reduce and prevent discrimination in the provision of prenatal care, labor and delivery, and postpartum care.
  • Authorizes $65,000,000/year for FY 2020-2024 for CDC to fund a competitive grant program for the establishment or support of perinatal quality collaboratives.
  • Authorizes $15,000,000/year for FY 2020-2024 for grants to establish or operate evidence-based or innovative, evidence-informed programs to deliver integrated healthcare services to pregnant and postpartum women. The Secretary of HHS would be required to submit a report on the outcomes of these activities by 2026.
H.R. 1897, MOMMA’s Act

&

S.916, MOMMA’s Act

Rep. Robin Kelly (D-IL)

105 Cosponsors
(104 Democrats, 1 Republican)

&

Sen. Richard Durbin (D-IL)

24 Cosponsors
(15 Democrats, 2 Independents)

 

 

 

Referred to the House Committee on Energy and Commerce

&

Referred to Senate Committee on Finance

— Supporting training for clinicians on implicit bias and  health equity

— Extending Medicaid postpartum coverage

— Funding for states to enhance data collection and strengthen perinatal quality collaboratives

 

Goal: to improve federal efforts to support states in their work to end preventable maternal morbidity and mortality.

  • Establishes a grant program ($5,000,000 a year to regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions).
  • Mandates the director of the Centers for Disease Control and Prevention (CDC) in consultation with the Administrator of HRSA will provide technical assistance to states + report comprehensive maternal mortality data.
  • The CDC director will also have to, within one year of enactment, release best practices information. This program will appropriated $5,000,000/year for FY 2019-2023. There will also be an alliance for innovation and maternal (AIM) health grant program through which the Secretary of Health and Human Services (HHS) will reward grants for the purpose of implementing maternal safety procedures and collecting and analyzing the implementation data. This program will be appropriated $10,000,000/year for FY 2019-2023.
  • Expansion of Medicaid and CHIP benefits for pregnant women to include oral health services.
  • Expansion of postpartum coverage under Medicaid and CHIP from 60 days to 1 year, with 100% federal financing for the first five years and 90% thereafter for expenses resulting from the expansion.
  • Maintenance of effort requirement for states to maintain Medicaid eligibility for pregnant women at current levels for five years after enactment
  • Gives states the option to extend SNAP benefits to women for two years postpartum.
  • Directs HHS to establish Centers of Excellence on cultural competency training for health care providers.
  • Establishes $14,000,000/year for 2020-2024 to fund state-based perinatal quality collaboratives, which will be multi-disciplinary teams that work to improve measurable outcomes in maternal and infant health and work with hospitals or outpatient facilities to improve perinatal outcomes.
H.R. 1551, Quality Care for Moms and Babies Act

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S. 1960, Quality Care for Moms and Babies Act

Rep. Eliot Engel (D-NY)

26 Cosponsors
(23 Democrats, 3 Republicans)

&

Sen. Debbie Stabenow (D-MI)

1 Cosponsor
(1 Republican)

Referred to the House Committee on Energy and Commerce – Subcommittee on Health

&

Referred to Senate Committee on Finance

— Funding for states to enhance data collection on maternal health Goal: to improve quality, health outcomes and value of maternity care under Medicaid and CHIP by developing quality measures for maternal and infant health, and standardized data collection and reporting of such measures. Includes collection and publication of survey data from providers, facilities and health plans.

  • Authorizes $16,000,000 for development and reporting of quality measures on maternal and infant health:
    • Secretary of HHS will identify and publish for comment a recommended set of maternal and infant health quality measures applicable to Medicaid and CHIP eligible mothers and infants. Requires standardized reporting to Congress within the first year, and every 3 years after.
    • Requires Agency of Healthcare Research and Quality (AHRQ) to adapt  surveys of providers, facilities and health plans, to assess effective measures maternity care.
    • Annual state reports regarding state-specific maternal and infant quality of care measures under Medicaid or CHIP.
  • Authorizes $15,000,000 for HHS to make grants to states and other entitles to establish and improve maternal and infant care collaboratives and for related  quality improvement activities.
H.R. 2902, Maternal Care Access and Reducing Emergencies Act

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S. 1600,  Maternal Care Access and Reducing Emergencies Act

Rep. Alma Adams (D-NC)

18 Cosponsors
(18 Democrats)

&

Sen. Kamala Harris (D-CA)

20 Cosponsors
(19 Democrats, 1 Independent)

Referred to the House Committee on Energy and Commerce

&

Referred to Senate Committee on Health, Education, Labor, and Pensions

— Supporting training for clinicians on implicit bias and  health equity Goal: to improve federal efforts with respect to the prevention of maternal mortality and morbidity by using evidence-based quality improvement, such as implicit bias training.

  • Establishes a grant program ($5,000,000 a year from 2020-2024) to schools of allopathic, osteopathic, nursing, and other health professional fields to implement implicit bias training. Priority given to training with respect to obstetrics and gynecology.
  • Appropriates $25,000,000 a year for the Secretary to award grants to up to 10 states, to establish or operate state pregnancy medical home programs for women who are uninsured or enrolled in Medicaid, with priority given to states with large racial disparities in maternal mortality and morbidity.
  • Arranges for a National Academy of Medicine study and recommendations for bias recognition in clinical skills testing for health professional schools.
H.R. 2602, Healthy MOMMIES Act

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S. 1343, MOMMIES Act

 

 

Rep. Ayanna Pressley (D-MA)

41 Cosponsors
(41 Democrats)

&

Sen. Cory Booker (D-NJ)

7 Cosponsors
(7 Democrats)

Referred to the House Committee on Energy and Commerce

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Referred to Senate Committee on Finance

— Extending Medicaid postpartum coverage

— Raising payment rates for primary care services under Medicaid to Medicare levels

— Research on Medicaid coverage for doula care, telemedicine for maternity care

 

Goal: to amend Titles XIX and XXI of the Social Security Act to Improve Medicaid and Children’s Health Insurance Program for low-income mothers.

  • Extends continuous Medicaid and CHIP coverage for pregnant and postpartum women by amending the 60-day period to a 1-year period, with full benefits extended, including the coverage of oral health services.
  • Establishes a program run by the Secretary of HHS – the maternity care home demonstration project, which will provide grants to states to enter into arrangements with eligible entities to implement or expand a maternity care home model, with goals of decreasing severe maternal mortality and morbidity, lowering overall healthcare spending, and increasing access to coordinated, evidence-based maternity care treatment.
  • Requires the reapplication of Medicare payment rate floor to primary care services furnished under Medicaid and requires additional providers be included.
  • Requires MACPAC and the Centers for Medicare and Medicaid Services (CMS) to provide a report and guidance on increasing access to doula care for Medicaid beneficiaries.
  • Requires the GAO to provide a report on state Medicaid programs’ use of telemedicine to increase access to maternity care.
H.R. 4215, Excellence in Maternal Health Act of 2019

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S. 2586, Maternal Outcomes Matter (MOM) Act of 2019

Rep. Larry Buschon (R-IN)

14 Cosponsors
(2 Democrats, 12 Republicans)

&

Sen. Martha McSally (R-AZ)

1 Cosponsor
(1 Democrat)

Referred to the House Committee on Energy and Commerce

&

Referred to Senate Committee on Health, Education, Labor, and Pensions

— Supporting training for clinicians on implicit bias and  health equity

— Funding for states to enhance data collection and strengthen perinatal quality collaboratives

— Improving health care for Native American women

 

Goal: to improve maternal healthcare quality and perinatal care, training of health professionals and prevent discrimination in healthcare services (training in implicit bias). Would establish a program to award grants for the purposes of identifying/disseminating best practices to improve maternal health.

  • Authorizes $10,000,000/year for FY 2020-2024 for a competitive grant program to entities to innovate in maternal health, to develop and implement evidence-based practices to improve maternal and infant health care quality and outcomes and eliminate preventable maternal mortality and morbidity.
  • Appropriates $5,000,000/year for FY 2020-2024 for grants to accredited health care professional schools, to reduce and prevent discrimination in the provision of services related to prenatal care, labor and delivery, birthing, and postpartum care.
  • Increases amount for CDC grants for perinatal quality collaboratives from $58,000,000 to $65,000,000 for each FY 2020-2024.
  • Appropriates $15,000,000/year for FY 2020-2024 to establish or operate evidence based or innovative, evidence informed programs to deliver integrated healthcare services to optimize the health of women and their infants, with preference given to states, Indian Tribes, or Tribal organizations with the highest rates of maternal mortality and morbidity.
  • Requires HHS to contract for research study on reducing discrimination and implicit bias among maternity care providers.
H.R. 2778, Healthy Maternity and Obstetric Medicine Act

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S. 1481, Healthy Maternity and Obstetric Medicine Act

Rep. Bonnie Watson Coleman (D-NJ)

87 Cosponsors
(87 Democrats)

&

Sen. Sherrod Brown (D-OH)

24 Cosponsors
(23 Democrat, 1 Independent)

Referred to the House Committees on Energy and Commerce, Ways and Means, Oversight and Reform, Education and Labor

&

Referred to Senate Committee on Finance

 

— Extending Medicaid postpartum coverage

— Creates Special Enrollment Period for Pregnancy

— Closes gap in maternity coverage in private plans for some dependents

Goal: to amend the Public Health Service Act to provide for a special enrollment period of pregnant women and extend Medicaid coverage for pregnant and postpartum individuals through one year postpartum.

  • Requires most health plans, including most group health plans, and most federal employee health benefit plans to include a special enrollment period for eligible pregnant individuals, beginning on the date on which the pregnancy is reported to plan or is confirmed by a provider.
  • Requires coverage of maternity care services in private plans for all enrollees, including adult dependent children.
  • Requires the continuation of the Medicaid income eligibility standard for pregnant individuals and infants as the State specified in its State plan (whether approved or not) as of January 1, 2014 or by state legislation.
  • Amends the Social Security Act to require 12-month continuous coverage for pregnant individuals on Medicaid, changing the 60-day post-partum coverage requirement to a 1-year requirement.
H.R. 4243, Rural Maternal and Obstetric Modernization of Services Act (Rural MOMS)

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S.2373, Rural Maternal and Obstetric Modernization of Services Act (Rural MOMS)

Rep. Xochitl Torres Small (D-NM)

8 Cosponsors
(4 Democrats, 4 Republicans)

Sen. Tina Smith (D-MN)

8 Cosponsors
(4 Democrats, 3 Republicans, 1 Independent)

Referred to the House Committee on Energy and Commerce

&

Referred to Senate Committee on Health, Education, Labor, and Pensions

— Broadening obstetric workforce in rural communities

—  Supporting training for maternity care clinicians on implicit bias, social determinants of health, mental health  and  substance use

 

Goal: to improve obstetric care in rural areas through improving data, network grants, training, and telemedicine in these areas.

  • Requires the Secretary of HHS, acting through the Director of the CDC to expand, intensify, and coordinate the CDC efforts with respect to maternal mortality and morbidity.
  • Authorizes $3,000,000/year for FY 2020-2024 for rural obstetric network grants to establish of collaborative improvement and innovation networks to improve maternal health outcomes. These networks will assist pregnant women in rural areas in connecting with prenatal, labor, birth, and postpartum care options, identify successful delivery models for individuals in rural areas, and measure and address inequities in birth outcomes among rural residents, with an emphasis on Black and American Indian/Alaska Native residents.
  • Authorizes $5,000,000 /year for FY 2020-2024 for rural maternal and obstetric care training demonstrations on maternal mental health, maternal substance use disorder, social determinants of health that impact individuals living in rural communities, and implicit bias for physicians, medical residents, nurse practitioners, physician assistants, midwives, and non-clinical professionals such as doulas and community health workers.
H.R. 2751, Mamas First Act Rep. Gwen Moore (D-WI)

11 Cosponsors
(11 Democrats)

Referred to the House Committee on Energy and Commerce — Medicaid coverage for doula care Goal: to provide coverage under the Medicaid program for services provided by doulas and midwives.

  • Includes coverage for prenatal, delivery, and postpartum services provided by doulas and midwives.
H.R. 5189, Birth Access Benefiting Improved Essential Facility Services (BABIES) Act Rep. Katherine Clark (D-MA)

4 Cosponsors
(3 Democrats, 1 Republican)

Referred to the House Committee on Energy and Commerce — Medicaid coverage for freestanding birth centers Goal: to establish a Medicaid demonstration program for innovative payment models for freestanding birth center services.

  • Authorizes $25,000,000 for states to conduct demonstration programs to expand access to birth centers for Medicaid beneficiaries with low-risk pregnancies.
  • Outlines requirements for a prospective payment system and minimum level of pregnancy-related services for birth centers.
S. 116, Modernizing Obstetric Medicine Standards Act of 2019, or MOMS Act Sen. Kirsten Gillibrand (D-NY)

7 Cosponsors
(7 Democrats)

Referred to Senate Committee on Health, Education, Labor, and Pensions — Funding for states and hospitals to enhance efforts on maternal safety Goal: to address maternal mortality and morbidity.

  • Authorizes $5,000,000 annually for FY 2020-2024 for HHS to create new Alliance for Innovation on Maternal Health program to provide technical assistance to State-based teams in implementation of maternal safety bundles.
  • Authorizes $40,000,000 annually from 2020-2024 for HHS to award grants to States or hospitals on the implementation of safety bundles; requires grantees to analyze and report on impact of grants and pregnancy-associated deaths and morbidity.