I 

118TH CONGRESS 

2D SESSION H. R. 8317 

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 HOUSE OF REPRESENTATIVES 

MAY 8, 2024 

Ms. MOORE of Wisconsin (for herself, Ms. UNDERWOOD, Ms. ADAMS, Ms. 

PRESSLEY, and Mrs. DINGELL) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

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 var9 ies drastically for women by race and ethnicity. On 


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

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

3 live births for Black women, 49.2 deaths for Amer4 ican Indian and Alaskan Native women, and 28 

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

6 While maternal mortality disparately impacts Black 

7 women and indigenous women, this urgent public 

8 health crisis traverses race, ethnicity, socioeconomic 

9 status, educational background, and geography. 

10 (2) United States maternal mortality rates are 

11 the highest in the developed world and are increas12 ing rapidly. 

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

14 are likely preventable. 

15 (4) According to the National Institutes of 

16 Health, doula-assisted mothers are four times less 

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

18 likely to experience a birth complication involving 

19 themselves or their baby, and significantly more like20 ly to initiate breastfeeding. 

21 (5) Midwife-led care is associated with cost sav22 ings, decreased rates of intervention, lower cesarean 

23 rates, lower preterm birth rates, and healthier out24 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 (30), by striking ‘‘and’’ 

10 at the end; 

11 (B) by redesignating paragraph (31) as 

12 paragraph (32); and 

13 (C) by inserting after paragraph (30) the 

14 following new paragraph: 

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

17 culturally congruent manner (as defined in sub18 section (kk)) by doulas, midwives, and tribal mid19 wives (as those terms are defined in subsection (jj)), 

20 that is provided in the home, community, a hospital, 

21 birth center, clinic, health unit, or is furnished via 

22 telehealth to the extent authorized under State law; 

23 and’’; and 

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


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1 ‘‘(jj) DOULAS, MIDWIVES, AND TRIBAL MIDWIFE

2 DEFINED.—For purposes of subsection (a)(31): 

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

4 means an individual who— 

5 ‘‘(A) has completed 60 hours of 

6 foundational training; 

7 ‘‘(B) is certified by an organization, which 

8 has been established for not less than five years 

9 and which requires the completion of continuing 

10 education to maintain such certification, to pro11 vide non-medical advice, information, emotional 

12 support, and physical comfort to an individual 

13 during such individual’s pregnancy, childbirth, 

14 and postpartum period; and 

15 ‘‘(C) maintains such certification by com16 pleting such required continuing education. 

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

18 means a midwife who meets at a minimum the inter19 national definition of the midwife and global stand20 ards for midwifery education as established by the 

21 International Confederation of Midwives. 

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

23 ‘tribal midwife’ means an individual who is recog24 nized by an Indian tribe (as defined in section 4 of 


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

2 1603)) to practice midwifery for such tribe. 

3 ‘‘(kk) CULTURALLY CONGRUENT CARE DEFINED.— 

4 For purposes of subsection (a)(31), the term ‘culturally 

5 congruent care’, with respect to maternity care, means 

6 care that is provided in agreement with the preferred cul7 tural values, beliefs, worldview, language, and practices of 

8 the health care consumer and other stakeholders.’’. 

9 (b) REQUIRING MANDATORY COVERAGE UNDER

10 STATE PLAN.—Section 1902(a)(10)(A) of the Social Se11 curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 

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

13 inserting ‘‘(30), and (31)’’. 

14 (c) EFFECTIVE DATE.— 

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

16 the amendments made by this section shall apply 

17 with respect to medical assistance furnished on or 

18 after January 1, 2022. 

19 (2) EXCEPTION FOR STATE LEGISLATION.—In 

20 the case of a State plan under title XIX of the So21 cial Security Act (42 U.S.C. 1396 et seq.) that the 

22 Secretary of Health and Human Services determines 

23 requires State legislation in order for the respective 

24 plan to meet any requirement imposed by amend25 ments made by this section, the respective plan shall 


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1 not be regarded as failing to comply with the re2 quirements of such title solely on the basis of its 

3 failure to meet such an additional requirement be4 fore the first day of the first calendar quarter begin5 ning after the close of the first regular session of the 

6 State legislature that begins after the date of the en7 actment of this Act. For purposes of the previous 

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

9 legislative session, each year of the session shall be 

10 considered to be a separate regular session of the 

11 State legislature. 

Æ 


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