II 

118TH CONGRESS 

1ST SESSION S. 3090 

To amend titles XIX and XXI of the Social Security Act to improve Medicaid 

and the Children’s Health Insurance Program for low-income mothers. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 19, 2023 

Mr. BOOKER (for himself, Ms. BALDWIN, Ms. SMITH, Mr. BLUMENTHAL, Ms. 

STABENOW, Ms. WARREN, and Mr. SANDERS) introduced the following 

bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend titles XIX and XXI of the Social Security Act 

to improve Medicaid and the Children’s Health Insurance 

Program for low-income mothers. 

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 ‘‘Maximizing Outcomes 

5 for Moms through Medicaid Improvement and Enhance6 ment of Services Act’’ or the ‘‘MOMMIES Act’’. 


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1 SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR 

2 LOW-INCOME PREGNANT INDIVIDUALS. 

3 (a) EXTENDING CONTINUOUS MEDICAID AND CHIP 

4 COVERAGE FOR PREGNANT AND POSTPARTUM INDIVID5 UALS.— 

6 (1) MEDICAID.—Title XIX of the Social Secu7 rity Act (42 U.S.C. 1396 et seq.) is amended— 

8 (A) in section 1902(e)— 

9 (i) in paragraph (6), by striking ‘‘60- 

10 day period (beginning on the last day of 

11 her pregnancy)’’ and inserting ‘‘1-year pe12 riod beginning on the last day of the preg13 nancy (or such longer period beginning on 

14 such day as the State may elect)’’; and 

15 (ii) by striking paragraph (16); 

16 (B) in section 1902(l)(1)(A), by striking 

17 ‘‘60-day period beginning on the last day of the 

18 pregnancy’’ and inserting ‘‘1-year period begin19 ning on the last day of the pregnancy or such 

20 longer period beginning on such day as the 

21 State may elect’’; 

22 (C) in section 1903(v)(4)(A)(i), by striking 

23 ‘‘60-day period beginning on the last day of the 

24 pregnancy’’ and inserting ‘‘1-year period begin25 ning on the last day of the pregnancy or such 


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1 longer period beginning on such day as the 

2 State may elect’’; and 

3 (D) in section 1905(a), in the 4th sentence 

4 in the matter following the last numbered para5 graph of such section, by striking ‘‘60-day pe6 riod beginning on the last day of her preg7 nancy’’ and inserting ‘‘1-year period beginning 

8 on the last day of the pregnancy, or such longer 

9 period beginning on such day as the State may 

10 elect,’’. 

11 (2) CHIP.—Section 2112 of the Social Security 

12 Act (42 U.S.C. 1397ll) is amended— 

13 (A) in subsection (d)(2)(A), by striking 

14 ‘‘60-day period’’ and all that follows through 

15 the semicolon and inserting ‘‘1-year period be16 ginning on the last day of the pregnancy, or 

17 such longer period beginning on such day as the 

18 State may elect, ends;’’; and 

19 (B) in subsection (f)(2), by striking ‘‘60- 

20 day period (beginning on the last day of the 

21 pregnancy)’’ and inserting ‘‘1-year period begin22 ning on the last day of the pregnancy, or such 

23 longer period beginning on such day as the 

24 State may elect,’’. 


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1 (b) REQUIRING FULL BENEFITS FOR PREGNANT

2 AND POSTPARTUM INDIVIDUALS.— 

3 (1) IN GENERAL.—Paragraph (5) of section 

4 1902(e) of the Social Security Act (24 U.S.C. 

5 1396a(e)) is amended to read as follows: 

6 ‘‘(5) COVERAGE OF FULL BENEFITS FOR AT

7 LEAST 1 YEAR FOR PREGNANT AND POSTPARTUM IN8 DIVIDUALS.— 

9 ‘‘(A) IN GENERAL.—Any individual who, 

10 while pregnant, is eligible for and has received 

11 medical assistance under the State plan ap12 proved under this title or a waiver of such plan 

13 (including during a period of retroactive eligi14 bility under subsection (a)(34)) shall continue 

15 to be eligible under the plan or waiver for med16 ical assistance through the end of the month in 

17 which the 1-year period beginning on the last 

18 day of the pregnancy, or such longer period be19 ginning on such day as the State may elect, 

20 ends, regardless of the basis for the individual’s 

21 eligibility for medical assistance, including if the 

22 individual’s eligibility for medical assistance is 

23 on the basis of being pregnant. 

24 ‘‘(B) SCOPE OF BENEFITS.—The medical 

25 assistance provided for a pregnant or 


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1 postpartum individual described in subpara2 graph (A) shall— 

3 ‘‘(i) include all items and services cov4 ered under the State plan (or waiver) that 

5 are not less in amount, duration, or scope, 

6 or are determined by the Secretary to be 

7 substantially equivalent, to the medical as8 sistance available for an individual de9 scribed in subsection (a)(10)(A)(i); and 

10 ‘‘(ii) be provided for the individual 

11 while pregnant and during the 1-year pe12 riod that begins on the last day of the 

13 pregnancy, or such longer period beginning 

14 on such day as the State may elect, and 

15 ends on the last day of the month in which 

16 such period ends.’’. 

17 (2) CONFORMING AMENDMENTS.— 

18 (A) Section 1902(a)(10) of the Social Se19 curity Act (42 U.S.C. 1396a(a)(10)) is amend20 ed in the matter following subparagraph (G) by 

21 striking ‘‘(VII) the medical assistance’’ and all 

22 that follows through ‘‘during the period de23 scribed in such section,’’. 


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1 (B) Section 2107(e)(1)(J) of the Social Se2 curity Act (42 U.S.C. 1397gg(e)(1)(J)) is 

3 amended— 

4 (i) by striking ‘‘Paragraphs (5) and 

5 (16)’’ and inserting ‘‘Paragraph (5)’’; and 

6 (ii) by striking ‘‘(relating to’’ and all 

7 that follows through the period and insert8 ing ‘‘(relating to the provision of medical 

9 assistance to pregnant individuals during 

10 and following pregnancy under title 

11 XIX).’’. 

12 (c) REQUIRING COVERAGE OF ORAL HEALTH SERV13 ICES FOR PREGNANT AND POSTPARTUM INDIVIDUALS.— 

14 (1) MEDICAID.—Section 1905 of the Social Se15 curity Act (42 U.S.C. 1396d) is amended— 

16 (A) in subsection (a)(4)— 

17 (i) by striking ‘‘; and (D)’’ and insert18 ing ‘‘; (D)’’; 

19 (ii) by striking ‘‘; and (E)’’ and in20 serting ‘‘; (E)’’; 

21 (iii) by striking ‘‘; and (F)’’ and in22 serting ‘‘; (F)’’; and 

23 (iv) by inserting ‘‘; and (G) oral 

24 health services for pregnant and 

25 postpartum individuals (as defined in subVerDate Sep 11 2014 20:35 Oct 20, 2023 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3090.IS S3090

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1 section (jj))’’ after ‘‘(or waiver of such 

2 plan)’’; and 

3 (B) by adding at the end the following new 

4 subsection: 

5 ‘‘(jj) ORAL HEALTH SERVICES FOR PREGNANT AND

6 POSTPARTUM INDIVIDUALS.— 

7 ‘‘(1) IN GENERAL.—For purposes of this title, 

8 the term ‘oral health services for pregnant and 

9 postpartum individuals’ means dental services nec10 essary to prevent disease and promote oral health, 

11 restore oral structures to health and function, and 

12 treat emergency conditions that are furnished to an 

13 individual during pregnancy (or during the 1 year 

14 period that begins on the last day of the pregnancy, 

15 or such longer period beginning on such day as the 

16 State may elect). 

17 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 

18 the requirement to provide oral health services for 

19 pregnant and postpartum individuals, a State shall, 

20 at a minimum, provide coverage for preventive, diag21 nostic, periodontal, and restorative care consistent 

22 with recommendations for comprehensive perinatal 

23 oral health services and dental services during preg24 nancy from the American Academy of Pediatric 


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1 Dentistry and the American College of Obstetricians 

2 and Gynecologists.’’. 

3 (2) CHIP.—Section 2103(c)(6)(A) of the Social 

4 Security Act (42 U.S.C. 1397cc(c)(6)(A)) is amend5 ed by inserting ‘‘or a targeted low-income pregnant 

6 individual’’ after ‘‘targeted low-income child’’. 

7 (3) TECHNICAL AMENDMENT.—Section 

8 2112(d)(2) of the Social Security Act (42 U.S.C. 

9 1397ll(d)(2)) is amended— 

10 (A) in the paragraph header, by inserting 

11 ‘‘; TARGETED LOW-INCOME PREGNANT INDI12 VIDUAL’’ after ‘‘WOMAN’’; and 

13 (B) by striking ‘‘the term ‘targeted low-in14 come pregnant woman’ means’’ and inserting 

15 ‘‘the terms ‘targeted low-income pregnant 

16 woman’ and ‘targeted low-income pregnant indi17 vidual’ mean’’. 

18 (d) MAINTENANCE OF EFFORT.— 

19 (1) MEDICAID.—Section 1902 of the Social Se20 curity Act (42 U.S.C. 1396a) is amended— 

21 (A) in paragraph (74), by striking ‘‘sub22 section (gg); and’’ and inserting ‘‘subsections 

23 (gg) and (uu);’’; and 

24 (B) by adding at the end the following new 

25 subsection: 


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1 ‘‘(uu) MAINTENANCE OF EFFORT RELATED TO LOW2 INCOME PREGNANT INDIVIDUALS.—For calendar quar3 ters beginning on or after the date of enactment of this 

4 subsection, and before January 1, 2025, no Federal pay5 ment shall be made to a State under section 1903(a) for 

6 amounts expended under a State plan under this title or 

7 a waiver of such plan if the State— 

8 ‘‘(1) has in effect under such plan eligibility 

9 standards, methodologies, or procedures (including 

10 any enrollment cap or other numerical limitation on 

11 enrollment, any waiting list, any procedures designed 

12 to delay the consideration of applications for enroll13 ment, any income counting rules, or similar limita14 tion with respect to enrollment) for individuals de15 scribed in subsection (l)(1) who are eligible for med16 ical assistance under the State plan or waiver under 

17 subsection (a)(10)(A)(ii)(IX) that are more restric18 tive than the eligibility standards, methodologies, or 

19 procedures, respectively, for such individuals under 

20 such plan or waiver that are in effect on the date 

21 of the enactment of the Maximizing Outcomes for 

22 Moms through Medicaid Improvement and Enhance23 ment of Services Act; or 

24 ‘‘(2) reduces the amount, duration, or scope of 

25 medical assistance available to individuals described 


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1 in subsection (l)(1) who are eligible for medical as2 sistance under such plan or waiver under subsection 

3 (a)(10)(A)(ii)(IX) from what the State provided to 

4 such individuals under such plan or waiver on the 

5 date of the enactment of the Maximizing Outcomes 

6 for Moms through Medicaid Improvement and En7 hancement of Services Act.’’. 

8 (2) CHIP.—Section 2112 of the Social Security 

9 Act (42 U.S.C. 1397ll), as amended by subsection 

10 (a), is further amended by adding at the end the fol11 lowing subsection: 

12 ‘‘(g) MAINTENANCE OF EFFORT.—For calendar 

13 quarters beginning on or after January 1, 2024, and be14 fore January 1, 2028, no payment may be made under 

15 section 2105(a) with respect to a State child health plan 

16 if the State— 

17 ‘‘(1) has in effect under such plan eligibility 

18 standards, methodologies, or procedures (including 

19 any enrollment cap or other numerical limitation on 

20 enrollment, any waiting list, any procedures designed 

21 to delay the consideration of applications for enroll22 ment, or similar limitation with respect to enroll23 ment) for targeted low-income pregnant individuals 

24 that are more restrictive than the eligibility stand25 ards, methodologies, or procedures, respectively, 


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1 under such plan that are in effect on the date of the 

2 enactment of the Maximizing Outcomes for Moms 

3 through Medicaid Improvement and Enhancement of 

4 Services Act; or 

5 ‘‘(2) provides pregnancy-related assistance to 

6 targeted low-income pregnant individuals under such 

7 plan at a level that is less than the level at which 

8 the State provides such assistance to such individ9 uals under such plan on the date of the enactment 

10 of the Maximizing Outcomes for Moms through 

11 Medicaid Improvement and Enhancement of Services 

12 Act.’’. 

13 (e) ENHANCED FMAP.—Section 1905 of the Social 

14 Security Act (42 U.S.C. 1396d), as amended by sub15 section (c), is further amended— 

16 (1) in subsection (b), by striking ‘‘and (ii)’’ and 

17 inserting ‘‘(ii), and (kk)’’; and 

18 (2) by adding at the end the following new sub19 section: 

20 ‘‘(kk) INCREASED FMAP FOR ADDITIONAL EXPEND21 ITURES FOR LOW-INCOME PREGNANT INDIVIDUALS.— 

22 For calendar quarters beginning on or after January 1, 

23 2024, notwithstanding subsection (b), the Federal medical 

24 assistance percentage for a State, with respect to the addi25 tional amounts expended by such State for medical assistVerDate Sep 11 2014 20:35 Oct 20, 2023 Jkt 049200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3090.IS S3090

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1 ance under the State plan under this title or a waiver of 

2 such plan that are attributable to requirements imposed 

3 by the amendments made by the Maximizing Outcomes 

4 for Moms through Medicaid Improvement and Enhance5 ment of Services Act (as determined by the Secretary), 

6 shall be equal to 100 percent.’’. 

7 (f) GAO STUDY AND REPORT.— 

8 (1) IN GENERAL.—Not later than 1 year after 

9 the date of the enactment of this Act, the Comp10 troller General of the United States shall submit to 

11 Congress a report on the gaps in coverage for— 

12 (A) pregnant individuals under the Med13 icaid program under title XIX of the Social Se14 curity Act (42 U.S.C. 1396 et seq.) and the 

15 Children’s Health Insurance Program under 

16 title XXI of the Social Security Act (42 U.S.C. 

17 1397aa et seq.); 

18 (B) postpartum individuals under the Med19 icaid program and the Children’s Health Insur20 ance Program who received assistance under ei21 ther such program during their pregnancy; and 

22 (C) birthing people between the ages of 15 

23 and 49 under the Medicaid program. 


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1 (2) CONTENT OF REPORT.—The report re2 quired under this subsection shall include the fol3 lowing: 

4 (A) Information about the abilities and 

5 successes of State Medicaid agencies in deter6 mining whether pregnant and postpartum indi7 viduals are eligible under another insurance af8 fordability program, and in transitioning any 

9 such individuals who are so eligible to coverage 

10 under such a program at the end of their period 

11 of eligibility for medical assistance, pursuant to 

12 section 435.1200 of the title 42, Code of Fed13 eral Regulations (as in effect on September 1, 

14 2018). 

15 (B) Information on factors contributing to 

16 gaps in coverage that disproportionately impact 

17 underserved populations, including low-income 

18 individuals, Black, Indigenous, and other indi19 viduals of color, individuals who reside in a 

20 health professional shortage area (as defined in 

21 section 332(a)(1)(A) of the Public Health Serv22 ice Act (42 U.S.C. 254e(a)(1)(A))) or individ23 uals who are members of a medically under24 served population (as defined by section 


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1 330(b)(3) of such Act (42 U.S.C. 

2 254b(b)(3)(A))). 

3 (C) Recommendations for addressing and 

4 reducing such gaps in coverage. 

5 (D) Such other information as the Comp6 troller General deems necessary. 

7 (3) DATA DISAGGREGATION.—To the greatest 

8 extent possible, the Comptroller General shall 

9 dissagregate data presented in the report, including 

10 by age, gender identity, race, ethnicity, income level, 

11 and other demographic factors. 

12 (g) EFFECTIVE DATE.—The amendments made by 

13 subsections (a) and (b) shall take effect on January 1, 

14 2024. 

15 SEC. 3. MATERNITY CARE HOME DEMONSTRATION 

16 PROJECT. 

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

18 et seq.) is amended by inserting the following new section 

19 after section 1947: 

20 ‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 

21 PROJECT. 

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

23 date of the enactment of this section, the Secretary shall 

24 establish a demonstration project (in this section referred 

25 to as the ‘demonstration project’) under which the SecVerDate Sep 11 2014 20:35 Oct 20, 2023 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S3090.IS S3090

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1 retary shall provide grants to States to enter into arrange2 ments with eligible entities to implement or expand a ma3 ternity care home model for eligible individuals. 

4 ‘‘(b) DEFINITIONS.—In this section: 

5 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en6 tity’ means an entity or organization that provides 

7 medically accurate, comprehensive maternity services 

8 to individuals who are eligible for medical assistance 

9 under a State plan under this title or a waiver of 

10 such a plan, and may include: 

11 ‘‘(A) A freestanding birth center. 

12 ‘‘(B) An entity or organization receiving 

13 assistance under section 330 of the Public 

14 Health Service Act. 

15 ‘‘(C) A federally qualified health center. 

16 ‘‘(D) A rural health clinic. 

17 ‘‘(E) A health facility operated by an In18 dian tribe or tribal organization (as those terms 

19 are defined in section 4 of the Indian Health 

20 Care Improvement Act). 

21 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

22 individual’ means a pregnant individual or a for23 merly pregnant individual during the 1-year period 

24 beginning on the last day of the pregnancy, or such 


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1 longer period beginning on such day as a State may 

2 elect, who is— 

3 ‘‘(A) enrolled in a State plan under this 

4 title, a waiver of such a plan, or a State child 

5 health plan under title XXI; and 

6 ‘‘(B) a patient of an eligible entity which 

7 has entered into an arrangement with a State 

8 under subsection (g). 

9 ‘‘(c) GOALS OF DEMONSTRATION PROJECT.—The 

10 goals of the demonstration project are the following: 

11 ‘‘(1) To improve— 

12 ‘‘(A) maternity and infant care outcomes; 

13 ‘‘(B) birth equity; 

14 ‘‘(C) health equity for— 

15 ‘‘(i) Black, Indigenous, and other peo16 ple of color; 

17 ‘‘(ii) lesbian, gay, bisexual, transgen18 der, queer, non-binary, and gender noncon19 firming individuals; 

20 ‘‘(iii) people who live in regions with 

21 limited or no access to obstetric care; 

22 ‘‘(iv) people with disabilities; and 

23 ‘‘(v) other underserved populations; 


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1 ‘‘(D) communication by and between ma2 ternity, infant care, and social services pro3 viders; 

4 ‘‘(E) integration of perinatal support serv5 ices, including community health workers, 

6 doulas, social workers, public health nurses, 

7 peer lactation counselors, lactation consultants, 

8 childbirth educators, peer mental health work9 ers, and others, into health care entities and or10 ganizations; 

11 ‘‘(F) care coordination between maternity, 

12 infant care, oral health services, and social serv13 ices providers within the community; 

14 ‘‘(G) the quality and safety of maternity 

15 and infant care; 

16 ‘‘(H) the experience of individuals receiv17 ing respectful maternity care, including by in18 creasing the ability of an individual to develop 

19 and follow their own birthing plans; and 

20 ‘‘(I) access to adequate prenatal and 

21 postpartum care, including— 

22 ‘‘(i) prenatal care that is initiated in 

23 a timely manner; 


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1 ‘‘(ii) not fewer than 5 post-pregnancy 

2 visits to a maternity care provider for 

3 postpartum care and support; 

4 ‘‘(iii) interpregnancy care; and 

5 ‘‘(iv) support and treatment for 

6 perinatal mood and anxiety disorders. 

7 ‘‘(2) To provide coordinated, evidence-based, re8 spectful, culturally and linguistically appropriate, 

9 and person-centered maternity care management. 

10 ‘‘(3) To decrease— 

11 ‘‘(A) preventable and severe maternal mor12 bidity and maternal mortality; 

13 ‘‘(B) overall health care spending; 

14 ‘‘(C) unnecessary emergency department 

15 visits; 

16 ‘‘(D) disparities in maternal and infant 

17 care outcomes, including racial, economic, dis18 ability, gender-based, and geographical dispari19 ties; 

20 ‘‘(E) racial, gender, economic, and other 

21 discrimination among among health care profes22 sionals; 

23 ‘‘(F) racism, discrimination, disrespect, 

24 trauma, and abuse in maternity care settings; 


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1 ‘‘(G) the rate of cesarean deliveries for 

2 low-risk pregnancies; 

3 ‘‘(H) the rate of preterm births and in4 fants born with low birth weight; 

5 ‘‘(I) the rate of avoidable maternal and 

6 newborn hospitalizations and admissions to in7 tensive care units; 

8 ‘‘(J) the rate of perinatal mood and anx9 iety disorders. 

10 ‘‘(d) CONSULTATION.—In designing and imple11 menting the demonstration project the Secretary shall 

12 consult with stakeholders, including— 

13 ‘‘(1) States; 

14 ‘‘(2) organizations representing relevant health 

15 care professionals, including oral health services pro16 fessionals; 

17 ‘‘(3) organizations, particularly reproductive 

18 justice and birth justice organizations led by people 

19 of color, that represent consumers of maternal 

20 health care, including consumers of maternal health 

21 care who are disproportionately impacted by poor 

22 maternal health outcomes; 

23 ‘‘(4) representatives with experience imple24 menting other maternity care home models, includVerDate Sep 11 2014 20:35 Oct 20, 2023 Jkt 049200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S3090.IS S3090

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1 ing representatives from the Center for Medicare 

2 and Medicaid Innovation; 

3 ‘‘(5) community-based health care professionals, 

4 including doulas, lactation consultants, and other 

5 stakeholders; 

6 ‘‘(6) experts in promoting health equity and 

7 combating racial bias in health care settings; and 

8 ‘‘(7) Black, Indigenous, and other maternal 

9 health care consumers of color who have experienced 

10 severe maternal morbidity. 

11 ‘‘(e) APPLICATION AND SELECTION OF STATES.— 

12 ‘‘(1) IN GENERAL.—A State seeking to partici13 pate in the demonstration project shall submit an 

14 application to the Secretary at such time and in 

15 such manner as the Secretary shall require. 

16 ‘‘(2) SELECTION OF STATES.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 select at least 10 States to participate in the 

19 demonstration project. 

20 ‘‘(B) SELECTION REQUIREMENTS.—In se21 lecting States to participate in the demonstra22 tion project, the Secretary shall— 

23 ‘‘(i) ensure that there is geographic 

24 and regional diversity in the areas in which 


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1 activities will be carried out under the 

2 project; 

3 ‘‘(ii) ensure that States with signifi4 cant disparities in maternal and infant 

5 health outcomes, including severe maternal 

6 morbidity, and other disparities based on 

7 race, income, or access to maternity care, 

8 are included; and 

9 ‘‘(iii) ensure that at least 1 territory 

10 is included. 

11 ‘‘(f) GRANTS.— 

12 ‘‘(1) IN GENERAL.—From amounts appro13 priated under subsection (l), the Secretary shall 

14 award 1 grant for each year of the demonstration 

15 project to each State that is selected to participate 

16 in the demonstration project. 

17 ‘‘(2) USE OF GRANT FUNDS.—A State may use 

18 funds received under this section to— 

19 ‘‘(A) award grants or make payments to 

20 eligible entities as part of an arrangement de21 scribed in subsection (g)(2); 

22 ‘‘(B) provide financial incentives to health 

23 care professionals, including community-based 

24 health care workers and community-based 


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1 doulas, who participate in the State’s maternity 

2 care home model; 

3 ‘‘(C) provide adequate training for health 

4 care professionals, including community-based 

5 health care workers, doulas, and care coordina6 tors, who participate in the State’s maternity 

7 care home model, which may include training 

8 for cultural humility and antiracism, racial bias, 

9 health equity, reproductive and birth justice, 

10 trauma-informed care, home visiting skills, and 

11 respectful communication and listening skills, 

12 particularly in regards to maternal health; 

13 ‘‘(D) pay for personnel and administrative 

14 expenses associated with designing, imple15 menting, and operating the State’s maternity 

16 care home model; 

17 ‘‘(E) pay for items and services that are 

18 furnished under the State’s maternity care 

19 home model and for which payment is otherwise 

20 unavailable under this title; 

21 ‘‘(F) pay for services and materials to en22 sure culturally and linguistically appropriate 

23 communication, including— 


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1 ‘‘(i) language services such as inter2 preters and translation of written mate3 rials; and 

4 ‘‘(ii) development of culturally and lin5 guistically appropriate materials; and aux6 iliary aids and services; and 

7 ‘‘(G) pay for other costs related to the 

8 State’s maternity care home model, as deter9 mined by the Secretary. 

10 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT

11 EVALUATOR.— 

12 ‘‘(A) IN GENERAL.—From the amounts 

13 appropriated under subsection (l), prior to 

14 awarding any grants under paragraph (1), the 

15 Secretary shall enter into a contract with a na16 tional external entity to create a single, uniform 

17 process to— 

18 ‘‘(i) ensure that States that receive 

19 grants under paragraph (1) comply with 

20 the requirements of this section; and 

21 ‘‘(ii) evaluate the outcomes of the 

22 demonstration project in each participating 

23 State. 

24 ‘‘(B) ANNUAL REPORT.—The contract de25 scribed in subparagraph (A) shall require the 


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1 national external entity to submit to the Sec2 retary— 

3 ‘‘(i) a yearly evaluation report for 

4 each year of the demonstration project; 

5 and 

6 ‘‘(ii) a final impact report after the 

7 demonstration project has concluded. 

8 ‘‘(C) SECRETARY’S AUTHORITY.—Nothing 

9 in this paragraph shall prevent the Secretary 

10 from making a determination that a State is 

11 not in compliance with the requirements of this 

12 section without the national external entity 

13 making such a determination. 

14 ‘‘(g) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 

15 ‘‘(1) IN GENERAL.—As a condition of receiving 

16 a grant under this section, a State shall enter into 

17 an arrangement with one or more eligible entities 

18 that meets the requirements of paragraph (2). 

19 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI20 TIES.—Under an arrangement between a State and 

21 an eligible entity under this subsection, the eligible 

22 entity shall perform the following functions, with re23 spect to eligible individuals enrolled with the entity 

24 under the State’s maternity care home model— 


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1 ‘‘(A) provide culturally and linguistically 

2 appropriate congruent care, which may include 

3 prenatal care, family planning services, medical 

4 care, mental and behavioral care, postpartum 

5 care, and oral health services to such eligible in6 dividuals through a team of health care profes7 sionals, which may include obstetrician-gyne8 cologists, maternal-fetal medicine specialists, 

9 family physicians, primary care providers, oral 

10 health providers, physician assistants, advanced 

11 practice registered nurses such as nurse practi12 tioners and certified nurse midwives, certified 

13 midwives, certified professional midwives, phys14 ical therapists, social workers, traditional and 

15 community-based doulas, lactation consultants, 

16 childbirth educators, community health workers, 

17 peer mental health supporters, and other health 

18 care professionals; 

19 ‘‘(B) conduct a risk assessment of each 

20 such eligible individual to determine if their 

21 pregnancy is high or low risk, and establish a 

22 tailored pregnancy care plan, which takes into 

23 consideration the individual’s own preferences 

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1 duce the individual’s medical, social, and envi2 ronmental risk factors, for each such eligible in3 dividual based on the results of such risk as4 sessment; 

5 ‘‘(C) assign each such eligible individual to 

6 a culturally and linguistically appropriate care 

7 coordinator, which may be a nurse, social work8 er, traditional or community-based doula, com9 munity health worker, midwife, or other health 

10 care provider, who is responsible for ensuring 

11 that such eligible individual receives the nec12 essary medical care and connections to essential 

13 support services; 

14 ‘‘(D) provide, or arrange for the provision 

15 of, essential support services, such as services 

16 that address— 

17 ‘‘(i) food access, nutrition, and exer18 cise; 

19 ‘‘(ii) smoking cessation; 

20 ‘‘(iii) substance use disorder and ad21 diction treatment; 

22 ‘‘(iv) anxiety, depression, trauma, and 

23 other mental and behavioral health issues; 


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1 ‘‘(v) breast feeding, chestfeeding, or 

2 other infant feeding options supports, initi3 ation, continuation, and duration; 

4 ‘‘(vi) stable, affordable, safe, and 

5 healthy housing; 

6 ‘‘(vii) transportation; 

7 ‘‘(viii) intimate partner violence; 

8 ‘‘(ix) community and police violence; 

9 ‘‘(x) home visiting services; 

10 ‘‘(xi) childbirth and newborn care edu11 cation; 

12 ‘‘(xii) oral health education; 

13 ‘‘(xiii) continuous labor support; 

14 ‘‘(xiv) group prenatal care; 

15 ‘‘(xv) family planning and contracep16 tive care and supplies; and 

17 ‘‘(xvi) affordable child care; 

18 ‘‘(E) as appropriate, facilitate connections 

19 to a usual primary care provider, which may be 

20 a reproductive health care provider; 

21 ‘‘(F) refer to guidelines and opinions of 

22 medical associations when determining whether 

23 an elective delivery should be performed on an 

24 eligible individual before 39 weeks of gestation; 


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1 ‘‘(G) provide such eligible individual with 

2 evidence-based and culturally and linguistically 

3 appropriate education and resources to identify 

4 potential warning signs of pregnancy and 

5 postpartum complications and when and how to 

6 obtain medical attention; 

7 ‘‘(H) provide, or arrange for the provision 

8 of, culturally and linguistically appropriate 

9 pregnancy and postpartum health services, in10 cluding family planning counseling and services, 

11 to eligible individuals; 

12 ‘‘(I) track and report postpartum health 

13 and birth outcomes of such eligible individuals 

14 and their children; 

15 ‘‘(J) ensure that care is person-centered, 

16 culturally and linguistically appropriate, and 

17 patient-led, including by engaging eligible indi18 viduals in their own care, including through 

19 communication and education; and 

20 ‘‘(K) ensure adequate training for appro21 priately serving the population of individuals el22 igible for medical assistance under the State 

23 plan or waiver of such plan, including through 

24 reproductive justice, birth justice, birth equity, 


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1 and anti-racist frameworks, home visiting skills, 

2 and knowledge of social services. 

3 ‘‘(h) TERM OF DEMONSTRATION PROJECT.—The 

4 Secretary shall conduct the demonstration project for a 

5 period of 5 years. 

6 ‘‘(i) WAIVER AUTHORITY.—To the extent that the 

7 Secretary determines necessary in order to carry out the 

8 demonstration project, the Secretary may waive section 

9 1902(a)(1) (relating to statewideness) and section 

10 1902(a)(10)(B) (relating to comparability). 

11 ‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 

12 establish a process to provide technical assistance to 

13 States that are awarded grants under this section and to 

14 eligible entities and other providers participating in a 

15 State maternity care home model funded by such a grant. 

16 ‘‘(k) REPORT.— 

17 ‘‘(1) IN GENERAL.—Not later than 18 months 

18 after the date of the enactment of this section and 

19 annually thereafter for each year of the demonstra20 tion project term, the Secretary shall submit a re21 port to Congress on the results of the demonstration 

22 project. 

23 ‘‘(2) FINAL REPORT.—As part of the final re24 port required under paragraph (1), the Secretary 

25 shall include— 


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1 ‘‘(A) the results of the final report of the 

2 national external entity required under sub3 section (f)(3)(B)(ii); and 

4 ‘‘(B) recommendations on whether the 

5 model studied in the demonstration project 

6 should be continued or more widely adopted, in7 cluding by private health plans. 

8 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to the Secretary, for 

10 each of fiscal years 2024 through 2031, such sums as may 

11 be necessary to carry out this section.’’. 

12 SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE 

13 FLOOR TO PRIMARY CARE SERVICES FUR14 NISHED UNDER MEDICAID AND INCLUSION 

15 OF ADDITIONAL PROVIDERS. 

16 (a) REAPPLICATION OF PAYMENT FLOOR; ADDI17 TIONAL PROVIDERS.— 

18 (1) IN GENERAL.—Section 1902(a)(13) of the 

19 Social Security Act (42 U.S.C. 1396a(a)(13)) is 

20 amended— 

21 (A) in subparagraph (B), by striking ‘‘; 

22 and’’ and inserting a semicolon; 

23 (B) in subparagraph (C), by striking the 

24 semicolon and inserting ‘‘; and’’; and 


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1 (C) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(D) payment for primary care services (as 

4 defined in subsection (jj)(1)) furnished in the 

5 period that begins on the first day of the first 

6 month that begins after the date of enactment 

7 of the Maximizing Outcomes for Moms through 

8 Medicaid Improvement and Enhancement of 

9 Services Act by a provider described in sub10 section (jj)(2)— 

11 ‘‘(i) at a rate that is not less than 100 

12 percent of the payment rate that applies to 

13 such services and the provider of such 

14 services under part B of title XVIII (or, if 

15 greater, the payment rate that would be 

16 applicable under such part if the conver17 sion factor under section 1848(d) for the 

18 year were the conversion factor under such 

19 section for 2009); 

20 ‘‘(ii) in the case of items and services 

21 that are not items and services provided 

22 under such part, at a rate to be established 

23 by the Secretary; and 

24 ‘‘(iii) in the case of items and services 

25 that are furnished in rural areas (as deVerDate Sep 11 2014 20:35 Oct 20, 2023 Jkt 049200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S3090.IS S3090

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1 fined in section 1886(d)(2)(D)), health 

2 professional shortage areas (as defined in 

3 section 332(a)(1)(A) of the Public Health 

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

5 medically underserved areas (according to 

6 a designation under section 330(b)(3)(A) 

7 of the Public Health Service Act (42 

8 U.S.C. 254b(b)(3)(A))), at the rate other9 wise applicable to such items or services 

10 under clause (i) or (ii) increased, at the 

11 Secretary’s discretion, by not more than 25 

12 percent;’’. 

13 (2) CONFORMING AMENDMENTS.— 

14 (A) Section 1902(a)(13)(C) of the Social 

15 Security Act (42 U.S.C. 1396a(a)(13)(C)) is 

16 amended by striking ‘‘subsection (jj)’’ and in17 serting ‘‘subsection (jj)(1)’’. 

18 (B) Section 1905(dd) of the Social Secu19 rity Act (42 U.S.C. 1396d(dd)) is amended— 

20 (i) by striking ‘‘Notwithstanding’’ and 

21 inserting the following: 

22 ‘‘(1) IN GENERAL.—Notwithstanding’’; 

23 (ii) by striking ‘‘section 

24 1902(a)(13)(C)’’ and inserting ‘‘subpara25 graph (C) of section 1902(a)(13)’’; 


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1 (iii) by inserting ‘‘or for services de2 scribed in subparagraph (D) of section 

3 1902(a)(13) furnished during an additional 

4 period specified in paragraph (2),’’ after 

5 ‘‘2015,’’; 

6 (iv) by striking ‘‘under such section’’ 

7 and inserting ‘‘under subparagraph (C) or 

8 (D) of section 1902(a)(13), as applicable’’; 

9 and 

10 (v) by adding at the end the following: 

11 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 

12 paragraph (1), the following are additional periods: 

13 ‘‘(A) The period that begins on the first 

14 day of the first month that begins after the 

15 date of enactment of the Maximizing Outcomes 

16 for Moms through Medicaid Improvement and 

17 Enhancement of Services Act.’’. 

18 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec19 tion 1902(jj) of the Social Security Act (42 U.S.C. 

20 1396a(jj)) is amended— 

21 (1) by redesignating paragraphs (1) and (2) as 

22 clauses (i) and (ii), respectively and realigning the 

23 left margins accordingly; 

24 (2) by striking ‘‘For purposes of subsection 

25 (a)(13)(C)’’ and inserting the following: 


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1 ‘‘(1) IN GENERAL.— 

2 ‘‘(A) DEFINITION.—For purposes of sub3 paragraphs (C) and (D) of subsection (a)(13)’’; 

4 and 

5 (3) by inserting after clause (ii) (as so redesig6 nated) the following: 

7 ‘‘(B) EXCLUSIONS.—Such term does not 

8 include any services described in subparagraph 

9 (A) or (B) of paragraph (1) if such services are 

10 provided in an emergency department of a hos11 pital. 

12 ‘‘(2) ADDITIONAL PROVIDERS.—For purposes 

13 of subparagraph (D) of subsection (a)(13), a pro14 vider described in this paragraph is any of the fol15 lowing: 

16 ‘‘(A) A physician with a primary specialty 

17 designation of family medicine, general internal 

18 medicine, or pediatric medicine, or obstetrics 

19 and gynecology. 

20 ‘‘(B) An advanced practice clinician, as de21 fined by the Secretary, that works under the 

22 supervision of— 

23 ‘‘(i) a physician that satisfies the cri24 teria specified in subparagraph (A); 


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1 ‘‘(ii) a nurse practitioner or a physi2 cian assistant (as such terms are defined 

3 in section 1861(aa)(5)(A)) who is working 

4 in accordance with State law; or 

5 ‘‘(iii) or a certified nurse-midwife (as 

6 defined in section 1861(gg)) or a certified 

7 professional midwife who is working in ac8 cordance with State law. 

9 ‘‘(C) A rural health clinic, federally quali10 fied health center, health center that receives 

11 funding under title X of the Public Health 

12 Service Act, or other health clinic that receives 

13 reimbursement on a fee schedule applicable to 

14 a physician. 

15 ‘‘(D) An advanced practice clinician super16 vised by a physician described in subparagraph 

17 (A), another advanced practice clinician, or a 

18 certified nurse-midwife. 

19 ‘‘(E) A midwife who is working in accord20 ance with State law.’’. 

21 (c) ENSURING PAYMENT BY MANAGED CARE ENTI22 TIES.— 

23 (1) IN GENERAL.—Section 1903(m)(2)(A) of 

24 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 

25 is amended— 


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1 (A) in clause (xii), by striking ‘‘and’’ after 

2 the semicolon; 

3 (B) by realigning the left margin of clause 

4 (xiii) so as to align with the left margin of 

5 clause (xii) and by striking the period at the 

6 end of clause (xiii) and inserting ‘‘; and’’; and 

7 (C) by inserting after clause (xiii) the fol8 lowing: 

9 ‘‘(xiv) such contract provides that (I) payments 

10 to providers specified in section 1902(a)(13)(D) for 

11 primary care services defined in section 1902(jj) 

12 that are furnished during a year or period specified 

13 in section 1902(a)(13)(D) and section 1905(dd) are 

14 at least equal to the amounts set forth and required 

15 by the Secretary by regulation, (II) the entity shall, 

16 upon request, provide documentation to the State, 

17 sufficient to enable the State and the Secretary to 

18 ensure compliance with subclause (I), and (III) the 

19 Secretary shall approve payments described in sub20 clause (I) that are furnished through an agreed 

21 upon capitation, partial capitation, or other value22 based payment arrangement if the capitation, partial 

23 capitation, or other value-based payment arrange24 ment is based on a reasonable methodology and the 

25 entity provides documentation to the State sufficient 


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1 to enable the State and the Secretary to ensure com2 pliance with subclause (I).’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1932(f) of the Social Security Act (42 U.S.C. 

5 1396u–2(f)) is amended— 

6 (A) by striking ‘‘section 1902(a)(13)(C)’’ 

7 and inserting ‘‘subsections (C) and (D) of sec8 tion 1902(a)(13)’’; and 

9 (B) by inserting ‘‘and clause (xiv) of sec10 tion 1903(m)(2)(A)’’ before the period. 

11 SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREAS12 ING ACCESS TO DOULA SERVICES FOR MED13 ICAID BENEFICIARIES. 

14 (a) MACPAC REPORT.— 

15 (1) IN GENERAL.—Not later than 1 year after 

16 the date of the enactment of this Act, the Medicaid 

17 and CHIP Payment and Access Commission (re18 ferred to in this section as ‘‘MACPAC’’) shall pub19 lish a report on the coverage of doula services under 

20 State Medicaid programs, which shall at a minimum 

21 include the following: 

22 (A) Information about coverage for doula 

23 services under State Medicaid programs that 

24 currently provide coverage for such care, includ25 ing the type of doula services offered (such as 


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1 prenatal, labor and delivery, postpartum sup2 port, and community-based and traditional 

3 doula services), credentialing and provider en4 rollment requirements for doulas under State 

5 Medicaid programs, additional forms of support 

6 contributing to doula enrollment and reimburse7 ment under State Medicaid programs, and data 

8 on outcomes with respect to doula services 

9 under each State Medicaid program, including 

10 the number of doulas registered under the State 

11 Medicaid program, the number of pregnant, 

12 birthing, and postpartum people served by 

13 doulas under the State Medicaid program, and 

14 the amount of time it takes for doulas to re15 ceive payment under the State Medicaid pro16 gram for services provided under the program. 

17 (B) An analysis of barriers to covering 

18 doula services under State Medicaid programs. 

19 (C) An identification of effective strategies 

20 to increase the use of doula services in order to 

21 provide better care and achieve better maternal 

22 and infant health outcomes, including strategies 

23 that States may use to recruit, train, sutain, 

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1 nities of color, and communities facing lin2 guistic or cultural barriers. 

3 (D) Recommendations for legislative and 

4 administrative actions to increase access to 

5 doula services in State Medicaid programs, in6 cluding actions that ensure doulas may earn a 

7 sustainable living wage that accounts for their 

8 time and costs associated with providing care 

9 and community-based doula program adminis10 tration and operation. 

11 (2) STAKEHOLDER CONSULTATION.—In devel12 oping the report required under paragraph (1), 

13 MACPAC shall consult with relevant stakeholders, 

14 including— 

15 (A) States; 

16 (B) organizations, especially reproductive 

17 justice and birth justice organizations led by 

18 people of color, representing consumers of ma19 ternal health care, including those that are dis20 proportionately impacted by poor maternal 

21 health outcomes; 

22 (C) organizations and individuals rep23 resenting doulas, including community-based 

24 doula programs and those who serve under25 served communities, including communities of 


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1 color, and communities facing linguistic or cul2 tural barriers; 

3 (D) organizations representing health care 

4 providers; and 

5 (E) Black, Indigenous, and other maternal 

6 health care consumers of color who have experi7 enced severe maternal morbidity. 

8 (b) CMS GUIDANCE.— 

9 (1) IN GENERAL.—Not later than 1 year after 

10 the date that MACPAC publishes the report re11 quired under subsection (a)(1), the Administrator of 

12 the Centers for Medicare & Medicaid Services shall 

13 issue guidance to States on increasing access to 

14 doula services under Medicaid. Such guidance shall 

15 at a minimum include— 

16 (A) options for States to provide medical 

17 assistance for doula services under State Med18 icaid programs; 

19 (B) best practices for ensuring that doulas, 

20 including community-based doulas, receive reim21 bursement for doula services provided under a 

22 State Medicaid program, at a level that allows 

23 doulas to earn a living wage that accounts for 

24 their time and costs associated with providing 


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1 care and community-based doula program ad2 ministration; and 

3 (C) best practices for increasing access to 

4 doula services, including services provided by 

5 community-based doulas, under State Medicaid 

6 programs. 

7 (2) STAKEHOLDER CONSULTATION.—In devel8 oping the guidance required under paragraph (1), 

9 the Administrator of the Centers for Medicare & 

10 Medicaid Services shall consult with MACPAC and 

11 other relevant stakeholders, including— 

12 (A) State Medicaid officials; 

13 (B) organizations representing consumers 

14 of maternal health care, including those that 

15 are disproportionately impacted by poor mater16 nal health outcomes; 

17 (C) organizations representing doulas, in18 cluding community-based doulas and those who 

19 serve underserved communities, such as com20 munities of color and communities facing lin21 guistic or cultural barriers; 

22 (D) organizations representing medical 

23 professionals; and 

24 (E) maternal health advocacy organiza25 tions. 


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1 SEC. 6. GAO REPORT ON STATE MEDICAID PROGRAMS’ USE 

2 OF TELEHEALTH TO INCREASE ACCESS TO 

3 MATERNITY CARE. 

4 Not later than 1 year after the date of the enactment 

5 of this Act, the Comptroller General of the United States 

6 shall submit a report to Congress on State Medicaid pro7 grams’ use of telehealth to increase access to maternity 

8 care. Such report shall include the following: 

9 (1) The number of State Medicaid programs 

10 that utilize telehealth that increases access to mater11 nity care. 

12 (2) With respect to State Medicaid programs 

13 that utilize telehealth that increases access to mater14 nity care, information about— 

15 (A) common characteristics of such pro16 grams’ approaches to utilizing telehealth that 

17 increases access to maternity care; 

18 (B) differences in States’ approaches to 

19 utilizing telehealth to improve access to mater20 nity care, and the resulting differences in State 

21 maternal health outcomes, as determined by 

22 factors described in subsection (C); and 

23 (C) when compared to patients who receive 

24 maternity care in-person, what is known 

25 about— 


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1 (i) the demographic characteristics, 

2 such as race, ethnicity, sex, sexual orienta3 tion, gender identity, disability status, age, 

4 and preferred language of the individuals 

5 enrolled in such programs who use tele6 health to access maternity care; 

7 (ii) health outcomes for such individ8 uals, including frequency of mortality and 

9 severe morbidity, as compared to individ10 uals with similar characteristics who did 

11 not use telehealth to access maternity care; 

12 (iii) the services provided to individ13 uals through telehealth, including family 

14 planning services, mental health care serv15 ices, and oral health services; 

16 (iv) the devices and equipment pro17 vided to individuals for remote patient 

18 monitoring and telehealth, including blood 

19 pressure monitors and blood glucose mon20 itors; 

21 (v) the quality of maternity care pro22 vided through telehealth, including whether 

23 maternity care provided through telehealth 

24 is culturally and linguistically appropriate; 


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1 (vi) the level of patient satisfaction 

2 with an experience of maternity care pro3 vided through telehealth to individuals en4 rolled in State Medicaid programs; 

5 (vii) the impact of utilizing telehealth 

6 to increase access to maternity care on 

7 spending, cost savings, access to care, and 

8 utilization of care under State Medicaid 

9 programs; and 

10 (viii) the accessibility and effectiveness 

11 of telehealth for maternity care during the 

12 COVID–19 pandemic. 

13 (3) An identification and analysis of the bar14 riers to using telehealth to increase access to mater15 nity care under State Medicaid programs. 

16 (4) Recommendations for such legislative and 

17 administrative actions related to increasing access to 

18 telehealth maternity services under Medicaid as the 

19 Comptroller General deems appropriate. 

Æ 


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