Healthy Maternity and Obstetric Medicine Act

Summary: Healthy Maternity and Obstetric Medicine Act or the Healthy MOM Act This bill amends the Public Health Service Act and Internal Revenue Code to require health insurers, health insurance exchanges, and group health plans to offer a special enrollment period to pregnant individuals. The special enrollment period offered by an insurer or exchange must begin when the pregnancy is reported to the insurer or exchange. The special enrollment period offered by a group health plan must begin when the pregnancy is reported to the plan or is confirmed by a health care provider. Coverage offered by a group health plan or health insurer that covers dependents must provide coverage for maternity care to all covered individuals. The Office of Personnel Management must ensure that eligible pregnant women are allowed to enroll in federal employee health benefit plans outside of the open enrollment period. This bill amends title XIX (Medicaid) of the Social Security Act to revise the range in which a state must establish a maximum level of family income for pregnant women and infants to be eligible for Medicaid. The upper limit of the range is eliminated and the lower limit is set to the level in place, or specified in an amendment to a state plan, on January 1, 2014.

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 AND 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) The Patient Protection and Affordable Care Act has 
        greatly increased access to affordable health insurance 
        coverage for women. Today, more than 7,500,000 women have 
        access to health insurance because of the law. That Act made it 
        illegal to deny coverage based on pre-existing conditions, like 
        pregnancy, or charge women more money for their premiums. That 
        Act also required women's preventive services like birth 
        control to be covered without cost sharing.
            (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) 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.
            (10) Regular maternity care can reduce preterm births and 
        the health complications associated with preterm births.
            (11) Timely maternity 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 the 
                pregnancy is reported to the Exchange; and''.
    (c) Special Enrollment Periods.--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.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning after the 2016 plan year.

SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT CHILDREN.

    Section 2719A of the Public Health Service Act (42 U.S.C. 300gg-
19a) is amended by adding at the end the following:
    ``(e) 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, or enrollees, including dependents, including coverage 
of labor and delivery. Such coverage shall be provided to all pregnant 
dependents regardless of age.''.

SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.

    (a) 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.
    (b) Effective Date.--The requirement in subsection (a) 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.

SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR 
              PREGNANT WOMEN 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, 2014, 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 on or after January 1, 2014, 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, 2014, or
            ``(II) if no such percentage is specified as of January 1, 
        2014, 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. 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.