IB 

Union Calendar No. 428 

116TH CONGRESS 

2D SESSION H. R. 4996 

[Report No. 116–527] 

To amend title XIX of the Social Security Act to provide for a State option 

under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 8, 2019 

Ms. KELLY of Illinois (for herself, Mr. BURGESS, Ms. UNDERWOOD, Mrs. 

RODGERS of Washington, Ms. PRESSLEY, and Mr. CARTER of Georgia) 

introduced the following bill; which was referred to the Committee on Energy and Commerce 

SEPTEMBER 21, 2020 

Additional sponsors: Ms. HERRERA BEUTLER, Mr. WALDEN, Mr. ENGEL, 

Mrs. HAYES, Mr. TRONE, Mr. CRENSHAW, Mr. GUTHRIE, Mr. RUIZ, Ms. 

SCHAKOWSKY, Mr. FITZPATRICK, Mr. CUNNINGHAM, Ms. NORTON, Mr. 

LARSEN of Washington, Mr. CLAY, Mr. MCGOVERN, Ms. KENDRA S. 

HORN of Oklahoma, Ms. FINKENAUER, Mrs. AXNE, Ms. SHALALA, Mr. 

WALBERG, Mr. MCEACHIN, Mrs. FLETCHER, Mrs. BUSTOS, Mr. VAN

DREW, Ms. JACKSON LEE, Ms. DEAN, Mr. LAMB, Mrs. DAVIS of California, Ms. PORTER, Mrs. NAPOLITANO, and Ms. HOULAHAN

SEPTEMBER 21, 2020 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 


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[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on November 8, 2019] 

A BILL 

To amend title XIX of the Social Security Act to provide 

for a State option under the Medicaid program to provide 

for and extend continuous coverage for certain individuals, and for other purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Helping Medicaid Offer 

5 Maternity Services Act of 2019’’ or the ‘‘Helping MOMS 

6 Act of 2019’’. 

7 SEC. 2. STATE OPTION UNDER MEDICAID PROGRAM TO 

8 PROVIDE FOR AND EXTEND CONTINUOUS 

9 COVERAGE FOR CERTAIN INDIVIDUALS. 

10 (a) STATE OPTION TO EXTEND CONTINUOUS COV11 ERAGE FOR PREGNANT AND POSTPARTUM INDIVIDUALS.— 

12 Title XIX of the Social Security Act (42 U.S.C. 1396 et 

13 seq.) is amended— 

14 (1) in section 1902(e)(5), by inserting after ‘‘60- 

15 day period’’ the following: ‘‘or, at the option of the 

16 State, 1-year period’’; 

17 (2) in section 1902(e)(6), by inserting after ‘‘60- 

18 day period’’ the following: ‘‘or, at the option of the 

19 State, 1-year period’’; 

20 (3) in section 1902(l)(1)(A), by inserting after 

21 ‘‘60-day period’’ the following: ‘‘, or, at the option of 

22 the State, 1-year period,’’; 

23 (4) in section 1903(v)(4)(A)(i), by inserting after 

24 ‘‘60-day period’’ the following: ‘‘, or, at the option of 

25 the State, 1-year period,’’; and 


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1 (5) in section 1905(a), in the fourth sentence in 

2 the matter following paragraph (30), by inserting 

3 after ‘‘60-day period’’ the following: ‘‘, or, at the op4 tion of the State, 1-year period,’’. 

5 (b) STATE OPTION TO PROVIDE CONTINUOUS COV6 ERAGE FOR FULL BENEFITS FOR INDIVIDUALS WHO ARE

7 OR BECOME PREGNANT.—Section 1902(e)(6) of the Social 

8 Security Act (42 U.S.C. 1396a(e)(6)), as amended by sub9 section (a), is further amended— 

10 (1) by striking ‘‘(6) In the case of a pregnant 

11 woman’’ and inserting 

12 ‘‘(6)(A) In the case of a pregnant woman’’; and 

13 (2) by adding at the end the following: 

14 ‘‘(B)(i) At the option of the State, the State plan may 

15 provide that an individual who is eligible for medical as16 sistance under the State plan (or a waiver of such plan) 

17 or for child health assistance under title XXI and who is, 

18 or who while so eligible becomes, pregnant shall continue 

19 to be eligible for such medical assistance or child health as20 sistance, respectively, through the end of the month in which 

21 the 1-year period (beginning on the last day of such preg22 nancy) ends, regardless of the basis for the individual’s eli23 gibility for such medical assistance.’’. 

24 (c) INCREASE OF FMAP.—Section 1905 of the Social 

25 Security Act (42 U.S.C. 1396d) is amended— 


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1 (1) in subsection (b), in the first sentence, by 

2 striking ‘‘and (ff)’’ and inserting ‘‘(ff), and (gg)’’; and 

3 (2) by adding at the end the following new sub4 section: 

5 ‘‘(gg) SPECIFIED COVERAGE EXTENSION STATES.— 

6 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

7 (b), beginning January 1, 2020, in the case of a spec8 ified coverage extension State, for the initial extension 

9 calendar quarters with respect to such State, the Fed10 eral medical assistance percentage that would other11 wise apply to the State without application of this 

12 subsection, shall be increased by 5 percentage points. 

13 ‘‘(2) SPECIFIED COVERAGE EXTENSION STATE.— 

14 For purposes of this subsection, the term ‘specified 

15 coverage extension State’ means a State, the State 

16 plan of which has in effect the application of the 1– 

17 year period of continuous medical assistance pursu18 ant to each of paragraphs (5) and (6) of section 

19 1902(e). 

20 ‘‘(3) INITIAL EXTENSION CALENDAR QUARTER.— 

21 For purposes of this subsection, the term ‘initial ex22 tension calendar quarter’ means, with respect to a 

23 State, each calendar quarter occurring in the first fis24 cal year that the State is a specified coverage exten25 sion State.’’. 


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1 (d) APPLICATION TO CHIP OPTIONAL COVERAGE OF

2 TARGETED LOW-INCOME PREGNANT WOMEN.—Section 

3 2112 of the Social Security Act (42 U.S.C. 1397ll) is 

4 amended— 

5 (1) in subsection (d)(2)(A), by inserting after 

6 ‘‘60-day period’’ the following: ‘‘, or, at the option of 

7 the State, 1-year period’’; and 

8 (2) in subsection (f)(2), by inserting after ‘‘60- 

9 day period’’ the following: ‘‘, or, at the option of the 

10 State, 1-year period’’. 

11 (e) EFFECTIVE DATE.—The amendments made by this 

12 section shall apply with respect to eligibility determinations 

13 for items and services under State plans under title XIX 

14 of the Social Security Act (or a waiver of such a plan) (42 

15 U.S.C. 1396 et seq.) and under State child health plans 

16 under title XXI (or waiver of such a plan) made on or after 

17 January 1, 2020. 

18 SEC. 3. MACPAC REPORT. 

19 (a) IN GENERAL.—Not later than 1 year after the date 

20 of the enactment of this Act, the Medicaid and CHIP Pay21 ment and Access Commission (referred to in this section 

22 as ‘‘MACPAC’’) shall publish a report on the coverage of 

23 doula services under State Medicaid programs, which shall 

24 at a minimum include the following: 


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1 (1) Information about coverage for doula services 

2 under State Medicaid programs that currently pro3 vide coverage for such services, including the type of 

4 doula services offered (such as prenatal, labor and de5 livery, postpartum support, and also community6 based and traditional doula services). 

7 (2) An analysis of barriers to covering doula 

8 services under State Medicaid programs. 

9 (3) An identification of effective strategies to in10 crease the use of doula services in order to provide 

11 better care and achieve better maternal and infant 

12 health outcomes, including strategies that States may 

13 use to recruit, train, and certify a diverse doula 

14 workforce, particularly from underserved commu15 nities, communities of color, and communities facing 

16 linguistic or cultural barriers. 

17 (4) Recommendations for legislative and admin18 istrative actions to increase access to doula services in 

19 State Medicaid programs, including actions that en20 sure doulas may earn a living wage that accounts for 

21 their time and costs associated with providing care. 

22 (b) STAKEHOLDER CONSULTATION.—In developing the 

23 report required under subsection (a), MACPAC shall con24 sult with relevant stakeholders, including— 

25 (1) States; 


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1 (2) organizations representing consumers, in2 cluding those that are disproportionately impacted by 

3 poor maternal health outcomes; 

4 (3) organizations and individuals representing 

5 doula services providers, including community-based 

6 doula programs and those who serve underserved com7 munities, including communities of color, and com8 munities facing linguistic or cultural barriers; and 

9 (4) organizations representing health care pro10 viders. 

11 SEC. 4. GAO REPORT. 

12 (a) IN GENERAL.—Not later than 2 years after the 

13 date of the enactment of this Act and every five years there14 after, the Comptroller General of the United States shall 

15 submit to Congress a report on the State adoption, under 

16 the Medicaid program under title XIX of the Social Secu17 rity Act (42 U.S.C. 1396 et seq.) and the Children’s Health 

18 Insurance Program under title XXI of such Act, of extend19 ing coverage to 365 days postpartum pursuant to the provi20 sions of (and amendments made by this Act). Such report 

21 shall include the information and recommendations de22 scribed in subsection (b) and shall also identify ongoing 

23 gaps in coverage for— 


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1 (1) pregnant women under the Medicaid pro2 gram and the Children’s Health Insurance Program; 

3 and 

4 (2) postpartum women under the Medicaid pro5 gram and the Children’s Health Insurance Program 

6 who received assistance under either such program 

7 during their pregnancy. 

8 (b) CONTENT OF REPORT.—The report under sub9 section (a) shall include the following: 

10 (1) Information regarding the extent to which 

11 States have elected to extend coverage to 365 days 

12 postpartum pursuant to the provisions of (and 

13 amendments made by this Act), including which 

14 States make the election and when, impacts on 

15 perinatal insurance churn in those States compared 

16 to States that did not make such election, other health 

17 impacts of such election including regarding maternal 

18 mortality and morbidity rates, and impacts on State 

19 and Federal Medicaid spending. 

20 (2) Information about the abilities, successes, 

21 and challenges of State Medicaid agencies in— 

22 (A) transitioning their eligibility systems to 

23 incorporate such an election by a State and in 

24 determining whether pregnant and postpartum 


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1 women are eligible under another insurance af2 fordability program; and 

3 (B) transitioning any such women who are 

4 so eligible to coverage under such a program, 

5 pursuant to section 1943(b)(3) of the Social Se6 curity Act (42 U.S.C 1396w–3(b)(3)). 

7 (3) Information on factors contributing to ongo8 ing gaps in coverage resulting from women 

9 transitioning from coverage under the Medicaid pro10 gram or Children’s Health Insurance Program that 

11 disproportionately impact underserved populations, 

12 including low-income women, women of color, women 

13 who reside in a health professional shortage area (as 

14 defined in section 332(a)(1)(A) of the Public Health 

15 Service Act (42 U.S.C. 254e(a)(1)(A))), or who are 

16 members of a medically underserved population (as 

17 defined by section 330(b)(3) of such Act (42 U.S.C. 

18 254b(b)(3)(A))). 

19 (4) Recommendations for addressing and reduc20 ing such gaps in coverage. 

21 (5) Such other information as the Comptroller 

22 General determines appropriate. 


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1 SEC. 5. REPORT ON MEDICAID BUNDLED PAYMENTS FOR 

2 PREGNANCY-RELATED SERVICES. 

3 Not later than 2 years after the date of the enactment 

4 of this Act, the Medicaid and CHIP Payment Advisory 

5 Commission shall submit to Congress a report containing 

6 an analysis of the use of bundled payments for reimbursing 

7 health care providers with respect to pregnancy-related 

8 services furnished under State plans (or waivers of such 

9 plans) under title XIX of the Social Security Act (42 U.S.C. 

10 1396 et seq.). 


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Union Calendar No. 428 

116TH CONGRESS 

2D SESSION H. R. 4996 

[Report No. 116–527] 

A BILL 

To amend title XIX of the Social Security Act to 

purposes. coverage for certain individuals, and for other program to provide for and extend continuous provide for a State option under the Medicaid 

SEPTEMBER 21, 2020 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


pamtmann on DSKBC07HB2PROD with BILLS