II 

118TH CONGRESS 

2D SESSION S. 4304 

To amend title XIX of the Social Security Act to provide coverage under 

the Medicaid program for services provided by doulas and midwives, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 9, 2024 

Ms. WARREN (for herself, Mr. BOOKER, Mr. CASEY, Mr. PADILLA, Ms. 

DUCKWORTH, Mr. SANDERS, Mr. HEINRICH, and Mr. BLUMENTHAL) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to provide 

coverage under the Medicaid program for services provided by doulas and midwives, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Mamas First Act’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) According to the Centers for Disease Con8 trol and Prevention, the maternal mortality rate varVerDate Sep 11 2014 19:14 Jun 11, 2024 Jkt 049200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4304.IS S4304

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1 ies drastically for women by race and ethnicity. On 

2 average, there are 26.6 deaths per 100,000 live 

3 births for White women, 69.9 deaths per 100,000 

4 live births for Black women, 49.2 deaths for Amer5 ican Indian and Alaskan Native women, and 28 

6 deaths per 100,000 live births for Hispanic women. 

7 While maternal mortality disparately impacts Black 

8 women and indigenous women, this urgent public 

9 health crisis traverses race, ethnicity, socioeconomic 

10 status, educational background, and geography. 

11 (2) United States maternal mortality rates are 

12 the highest in the developed world and are increas13 ing rapidly. 

14 (3) Four out of five of these maternal deaths 

15 are likely preventable. 

16 (4) According to the National Institutes of 

17 Health, doula-assisted mothers are four times less 

18 likely to have a low-birth-weight baby, two times less 

19 likely to experience a birth complication involving 

20 themselves or their baby, and significantly more like21 ly to initiate breastfeeding. 

22 (5) Midwife-led care is associated with cost sav23 ings, decreased rates of intervention, lower cesarean 

24 rates, lower preterm birth rates, and healthier out25 comes for mothers and babies. 


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1 (6) Midwives may practice in any setting, in2 cluding the home, community, hospitals, birth cen3 ters, clinics, or health units. 

4 SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY 

5 DOULAS AND MIDWIVES. 

6 (a) IN GENERAL.—Section 1905 of the Social Secu7 rity Act (42 U.S.C. 1396d) is amended— 

8 (1) in subsection (a)— 

9 (A) in paragraph (31), by striking ‘‘and’’ 

10 at the end; 

11 (B) by redesignating paragraph (32) as 

12 paragraph (33); and 

13 (C) by inserting after paragraph (31) the 

14 following new paragraph: 

15 ‘‘(32) services and care, including prenatal, de16 livery, and postpartum care, that is provided in a 

17 culturally congruent manner by doulas, midwives, 

18 and tribal midwives (as those terms are defined in 

19 subsection (kk)), that is provided in the home, com20 munity, a hospital, birth center, clinic, health unit, 

21 or is furnished via telehealth to the extent author22 ized under State law; and’’; and 

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

24 ‘‘(kk) DOULAS, MIDWIVES, AND TRIBAL MIDWIFE

25 DEFINED.—For purposes of subsection (a)(32): 


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1 ‘‘(1) DOULAS DEFINED.—The term ‘doula’ 

2 means an individual who— 

3 ‘‘(A)(i) has completed 60 hours of 

4 foundational training; 

5 ‘‘(ii) is certified by an organization, which 

6 has been established for not less than five years 

7 and which requires the completion of continuing 

8 education to maintain such certification, to pro9 vide non-medical advice, information, emotional 

10 support, and physical comfort to an individual 

11 during such individual’s pregnancy, childbirth, 

12 and postpartum period; and 

13 ‘‘(iii) maintains such certification by com14 pleting such required continuing education; 

15 ‘‘(B) has received three letters of rec16 ommendation from former clients in the past 5 

17 years; or 

18 ‘‘(C) is already authorized to serve within 

19 the individual’s State. 

20 ‘‘(2) MIDWIVES DEFINED.—The term ‘midwife’ 

21 means a midwife who meets at a minimum the inter22 national definition of the midwife and global stand23 ards for midwifery education as established by the 

24 International Confederation of Midwives. 


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1 ‘‘(3) TRIBAL MIDWIFE DEFINED.—The term 

2 ‘tribal midwife’ means an individual who is recog3 nized by an Indian tribe (as defined in section 4 of 

4 the Indian Health Care Improvement Act (25 U.S.C. 

5 1603)) to practice midwifery for such tribe.’’. 

6 (b) REQUIRING MANDATORY COVERAGE UNDER

7 STATE PLAN.—Section 1902(a)(10)(A) of the Social Se8 curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 

9 matter preceding clause (i), by striking ‘‘and (30)’’ and 

10 inserting ‘‘(30), and (32)’’. 

11 (c) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—Subject to paragraph (2), 

13 the amendments made by this section shall apply 

14 with respect to medical assistance furnished on or 

15 after January 1, 2024. 

16 (2) EXCEPTION FOR STATE LEGISLATION.—In 

17 the case of a State plan under title XIX of the So18 cial Security Act (42 U.S.C. 1396 et seq.) that the 

19 Secretary of Health and Human Services determines 

20 requires State legislation in order for the respective 

21 plan to meet any requirement imposed by amend22 ments made by this section, the respective plan shall 

23 not be regarded as failing to comply with the re24 quirements of such title solely on the basis of its 

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1 fore the first day of the first calendar quarter begin2 ning after the close of the first regular session of the 

3 State legislature that begins after the date of the en4 actment of this Act. For purposes of the previous 

5 sentence, in the case of a State that has a 2-year 

6 legislative session, each year of the session shall be 

7 considered to be a separate regular session of the 

8 State legislature. 

Æ 


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