IIB 

116TH CONGRESS 

2D SESSION H. R. 4996 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2020 

Received; read twice and referred to the Committee on Finance 

AN ACT 

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. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Helping Medicaid 

3 Offer Maternity Services Act of 2020’’ or the ‘‘Helping 

4 MOMS Act of 2020’’. 

5 SEC. 2. MODIFICATIONS TO CERTAIN COVERAGE UNDER 

6 MEDICAID AND CHIP FOR PREGNANT AND 

7 POSTPARTUM WOMEN. 

8 (a) STATE OPTION.—Section 1902(e) of the Social 

9 Security Act (42 U.S.C. 1396a(e)) is amended by adding 

10 at the end the following new paragraph: 

11 ‘‘(16) EXTENDING CERTAIN COVERAGE FOR

12 PREGNANT AND POSTPARTUM WOMEN.—At the op13 tion of the State, the State plan (or waiver of such 

14 State plan) may provide that an individual who, 

15 while pregnant, is eligible for and has received med16 ical assistance under the State plan approved under 

17 this title (or waiver of such plan) (including during 

18 a period of retroactive eligibility under subsection 

19 (a)(34)) shall, in addition to remaining eligible 

20 under paragraph (5) for all pregnancy-related and 

21 postpartum medical assistance available under the 

22 State plan (or wavier) through the last day of the 

23 month in which the 60-day period (beginning on the 

24 last day of her pregnancy) ends, remain eligible 

25 under the State plan (or waiver) for medical assist26 ance and such medical assistance shall include all 


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1 services covered under the State plan (or waiver) 

2 that is not less in amount, duration, or scope, or is 

3 determined by the Secretary to be substantially 

4 equivalent, to the medical assistance available for an 

5 individual described in subsection (a)(10)(A)(i) for 

6 the period beginning on the first day occurring after 

7 the end of such 60-day period and ending on the last 

8 day of the month in which the one-year period (be9 ginning on the last day of her pregnancy) ends.’’. 

10 (b) APPLICATION TO CHIP.— 

11 (1) IN GENERAL.—Section 2107(e)(1) of the 

12 Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

13 amended— 

14 (A) by redesignating subparagraphs (J) 

15 through (S) as subparagraphs (K) through (T), 

16 respectively; and 

17 (B) by inserting after subparagraph (I) the 

18 following new subparagraph: 

19 ‘‘(J) In the case of a State that has elected 

20 to apply the option under section 1902(e)(16) 

21 with respect to coverage for pregnant and 

22 postpartum women under title XIX, the provi23 sions of such section with respect to coverage of 

24 pregnant and postpartum women under this 


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1 title, except that such coverage shall be required 

2 and not at the option of the State.’’. 

3 (2) OPTIONAL COVERAGE OF TARGETED LOW4 INCOME PREGNANT WOMEN.—Section 2112(d)(2)(A) 

5 of the Social Security Act (42 U.S.C. 

6 1397ll(d)(2)(A)) is amended by inserting after ‘‘60- 

7 day period’’ the following: ‘‘, or, in the case that sec8 tion 1902(e)(16) applies to the State child health 

9 plan (or waiver of such plan) pursuant to section 

10 2107(e)(1), the 1-year period’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply with respect to State elections 

13 made under paragraph (16) of section 1902(e) of the So14 cial Security Act (42 U.S.C. 1396a(e)), as added by sub15 section (a), under title XIX of the Social Security Act (42 

16 U.S.C. 1396 et seq.) on or after the first day of the first 

17 fiscal year quarter beginning at least one year after the 

18 date of the enactment of this Act. 

19 SEC. 3. MACPAC REPORT. 

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

21 date of the enactment of this Act, the Medicaid and CHIP 

22 Payment and Access Commission (referred to in this sec23 tion as ‘‘MACPAC’’) shall publish a report on the coverage 

24 of doula services under State Medicaid programs, which 

25 shall at a minimum include the following: 


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1 (1) Information about coverage for doula serv2 ices under State Medicaid programs that currently 

3 provide coverage for such services, including the type 

4 of doula services offered (such as prenatal, labor and 

5 delivery, 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 

10 increase 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 

13 may 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 

19 in State Medicaid programs, including actions that 

20 ensure doulas may earn a living wage that accounts 

21 for their time and costs associated with providing 

22 care. 

23 (b) STAKEHOLDER CONSULTATION.—In developing 

24 the report required under subsection (a), MACPAC shall 

25 consult with relevant stakeholders, including— 


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1 (1) States; 

2 (2) organizations representing consumers, in3 cluding those that are disproportionately impacted 

4 by poor maternal health outcomes; 

5 (3) organizations and individuals representing 

6 doula services providers, including community-based 

7 doula programs and those who serve underserved 

8 communities, including communities of color, and 

9 communities facing linguistic or cultural barriers; 

10 and 

11 (4) organizations representing health care pro12 viders. 

13 SEC. 4. GAO REPORT. 

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

15 date of the enactment of this Act and every five years 

16 thereafter, the Comptroller General of the United States 

17 shall submit to Congress a report on the State adoption, 

18 under the Medicaid program under title XIX of the Social 

19 Security Act (42 U.S.C. 1396 et seq.) and the Children’s 

20 Health Insurance Program under title XXI of such Act, 

21 of extending coverage to 365 days postpartum pursuant 

22 to the provisions of (and amendments made by this Act). 

23 Such report shall include the information and rec24 ommendations described in subsection (b) and shall also 

25 identify ongoing 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 

17 health impacts of such election including regarding 

18 maternal mortality and morbidity rates, and impacts 

19 on State 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 enact4 ment of this Act, the Medicaid and CHIP Payment Advi5 sory Commission shall submit to Congress a report con6 taining an analysis of the use of bundled payments for 

7 reimbursing health care providers with respect to preg8 nancy-related services furnished under State plans (or 

9 waivers of such plans) under title XIX of the Social Secu10 rity Act (42 U.S.C. 1396 et seq.). 

11 SEC. 6. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT 

12 FOR SINGLE SOURCE DRUGS AND INNO13 VATOR MULTIPLE SOURCE DRUGS. 

14 Section 1927(c)(2)(D) of the Social Security Act (42 

15 U.S.C. 1396r–8(c)(2)(D)) is amended by inserting after 

16 ‘‘December 31, 2009,’’ the following: ‘‘and before January 

17 1, 2023,’’. 

18 SEC. 7. MEDICAID IMPROVEMENT FUND. 

19 Section 1941(b)(3) of the Social Security Act (42 

20 U.S.C 1396w–1(b)(3)) is amended— 

21 (1) in subparagraph (A), by striking ‘‘for fiscal 

22 year 2025 and thereafter, $1,960,000,000’’ and in23 serting ‘‘for fiscal year 2022 and thereafter, 

24 $9,286,000,000’’; and 

25 (2) in subparagraph (B), by striking ‘‘fiscal 

26 year 2025’’ and inserting ‘‘fiscal year 2022’’. 


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1 SEC. 8. DETERMINATION OF BUDGETARY EFFECTS. 

2 The budgetary effects of this Act, for the purpose of 

3 complying with the Statutory Pay-As-You-Go Act of 2010, 

4 shall be determined by reference to the latest statement 

5 titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 

6 Act, submitted for printing in the Congressional Record 

7 by the Chairman of the House Budget Committee, pro8 vided that such statement has been submitted prior to the 

9 vote on passage. 

Passed the House of Representatives September 29, 

2020. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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