II 

118TH CONGRESS 

1ST SESSION S. 3509 

To amend title XXVII of the Public Health Service Act to provide for 

a special enrollment period for pregnant persons, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 13, 2023 

Mr. BROWN (for himself, Mr. KING, Ms. BALDWIN, Mr. CASEY, Ms. SMITH, 

Mr. BLUMENTHAL, Mr. VAN HOLLEN, Mr. MERKLEY, Mr. WHITEHOUSE, 

Ms. CORTEZ MASTO, Mr. KAINE, Ms. KLOBUCHAR, and Mr. BOOKER) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XXVII of the Public Health Service Act 

to provide for a special enrollment period for pregnant 

persons, 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 ‘‘Healthy Maternity and 

5 Obstetric Medicine Act’’ or the ‘‘Healthy MOM Act’’. 

6 SEC. 2. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 

7 FOR PREGNANT INDIVIDUALS. 

8 (a) SPECIAL ENROLLMENT PERIODS.— 


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1 (1) PUBLIC HEALTH SERVICE ACT.—Section 

2 2702(b)(2) of the Public Health Service Act (42 

3 U.S.C. 300gg–1(b)(2)) is amended by inserting ‘‘in4 cluding a special enrollment period for pregnant in5 dividuals, beginning on the date on which the preg6 nancy is reported to the health insurance issuer’’ be7 fore the period at the end. 

8 (2) PATIENT PROTECTION AND AFFORDABLE

9 CARE ACT.—Section 1311(c)(6) of the Patient Pro10 tection and Affordable Care Act (42 U.S.C. 

11 18031(c)(6)) is amended— 

12 (A) in subparagraph (C), by striking 

13 ‘‘and’’ at the end; 

14 (B) by redesignating subparagraph (D) as 

15 subparagraph (E); and 

16 (C) by inserting after subparagraph (C) 

17 the following new subparagraph: 

18 ‘‘(D) a special enrollment period for preg19 nant individuals, beginning on the date on 

20 which the pregnancy is reported to the Ex21 change; and’’. 

22 (3) INTERNAL REVENUE CODE.—Section 

23 9801(f) of the Internal Revenue Code of 1986 (26 

24 U.S.C. 9801(f)) is amended by adding at the end 

25 the following new paragraph: 


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1 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

2 ‘‘(A) IN GENERAL.—A group health plan 

3 shall permit an employee who is eligible, but 

4 not enrolled, for coverage under the terms of 

5 the plan (or a dependent of such an employee 

6 if the dependent is eligible, but not enrolled, for 

7 coverage under such terms) to enroll for cov8 erage under the terms of the plan upon preg9 nancy, with the special enrollment period begin10 ning on the date on which the pregnancy is re11 ported to the group health plan or the preg12 nancy is confirmed by a health care provider. 

13 ‘‘(B) REGULATIONS.—The Secretary shall 

14 promulgate regulations with respect to the spe15 cial enrollment period under subparagraph (A), 

16 including establishing a time period for preg17 nant individuals to enroll in coverage and effec18 tive date of such coverage.’’. 

19 (4) ERISA.—Section 701(f) of the Employee 

20 Retirement Income Security Act of 1974 (29 U.S.C. 

21 1181(f)) is amended by adding at the end the fol22 lowing: 

23 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

24 ‘‘(A) IN GENERAL.—A group health plan 

25 or health insurance issuer in connection with a 


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1 group health plan shall permit an employee who 

2 is eligible, but not enrolled, for coverage under 

3 the terms of the plan (or a dependent of such 

4 an employee if the dependent is eligible, but not 

5 enrolled, for coverage under such terms) to en6 roll for coverage under the terms of the plan 

7 upon pregnancy, with the special enrollment pe8 riod beginning on the date on which the preg9 nancy is reported to the group health plan or 

10 health insurance issuer or the pregnancy is con11 firmed by a health care provider. 

12 ‘‘(B) REGULATIONS.—The Secretary shall 

13 promulgate regulations with respect to the spe14 cial enrollment period under subparagraph (A), 

15 including establishing a time period for preg16 nant individuals to enroll in coverage and effec17 tive date of such coverage.’’. 

18 (b) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply with respect to plan years begin20 ning after December 31, 2024. 

21 SEC. 3. COVERAGE OF MATERNITY CARE FOR DEPENDENT 

22 CHILDREN. 

23 Section 2719A of the Public Health Service Act (42 

24 U.S.C. 300gg–19a) is amended— 


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1 (1) in subsection (e), by inserting ‘‘(other than 

2 subsection (f))’’ after ‘‘this section’’; and 

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

4 ‘‘(f) COVERAGE OF MATERNITY CARE.—A group 

5 health plan, or health insurance issuer offering group or 

6 individual health insurance coverage, that provides cov7 erage for dependants shall ensure that such plan or cov8 erage includes coverage for maternity care associated with 

9 pregnancy, childbirth, and postpartum care for all partici10 pants, beneficiaries, or enrollees, including dependants, in11 cluding coverage of labor and delivery. Such coverage shall 

12 be provided to all pregnant dependents regardless of age.’’. 

13 SEC. 4. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

14 (a) COVERAGE OF PREGNANCY.—The Director of the 

15 Office of Personnel Management shall issue such regula16 tions as are necessary to ensure that pregnancy is consid17 ered a change in family status and a qualifying life event 

18 for an individual who is eligible to enroll, but is not en19 rolled, in a health benefit plan under chapter 89 of title 

20 5, United States Code. 

21 (b) EFFECTIVE DATE.—The requirement in sub22 section (a) shall apply with respect to any contract entered 

23 into under section 8902 of such title beginning 12 months 

24 after the date of enactment of this Act. 


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1 SEC. 5. CONTINUATION OF MEDICAID INCOME ELIGIBILITY 

2 STANDARD FOR PREGNANT INDIVIDUALS 

3 AND INFANTS. 

4 Section 1902(l)(2)(A) of the Social Security Act (42 

5 U.S.C. 1396a(l)(2)(A)) is amended— 

6 (1) in clause (i), by striking ‘‘and not more 

7 than 185 percent’’; 

8 (2) in clause (ii)— 

9 (A) in subclause (I), by striking ‘‘and’’ 

10 after the comma; 

11 (B) in subclause (II), by striking the pe12 riod at the end and inserting ‘‘, and’’; and 

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

14 ‘‘(III) January 1, 2025, is the percentage pro15 vided under clause (v).’’; and 

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

17 clause: 

18 ‘‘(v) The percentage provided under clause (ii) for 

19 medical assistance provided on or after January 1, 2025, 

20 with respect to individuals described in subparagraph (A) 

21 or (B) of paragraph (1) shall not be less than— 

22 ‘‘(I) the percentage specified for such individ23 uals by the State in an amendment to its State plan 

24 (whether approved or not) as of January 1, 2014; or 

25 ‘‘(II) if no such percentage is specified as of 

26 January 1, 2014, the percentage established for 


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1 such individuals under the State’s authorizing legis2 lation or provided for under the State’s appropria3 tions as of that date.’’. 

4 SEC. 6. REQUIRING 12-MONTH CONTINUOUS COVERAGE 

5 FOR PREGNANT AND POSTPARTUM INDIVID6 UALS UNDER MEDICAID AND CHIP. 

7 (a) MEDICAID.—Section 1902 of the Social Security 

8 Act (42 U.S.C. 1396a) is amended— 

9 (1) in subsection (a)— 

10 (A) in paragraph (86), by striking ‘‘and’’ 

11 at the end; 

12 (B) in paragraph (87), by striking the pe13 riod at the end and inserting ‘‘; and’’; and 

14 (C) by inserting after paragraph (87) the 

15 following new paragraph: 

16 ‘‘(88) provide that the State plan is in compli17 ance with subsection (e)(16).’’; and 

18 (2) in subsection (e)(16)— 

19 (A) in subparagraph (A), by striking ‘‘At 

20 the option of the State, the State plan (or waiv21 er of such State plan) may provide’’ and insert22 ing ‘‘A State plan (or waiver of such State 

23 plan) shall provide’’; 

24 (B) in subparagraph (B), in the matter 

25 preceding clause (i), by striking ‘‘by a State 


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1 making an election under this paragraph’’ and 

2 inserting ‘‘under a State plan (or a waiver of 

3 such State plan)’’; and 

4 (C) by striking subparagraph (C). 

5 (b) CHIP.— 

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

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

8 amended to read as follows: 

9 ‘‘(J) Paragraphs (5) and (16) of section 

10 1902(e) (relating to the requirement to provide 

11 medical assistance under the State plan or 

12 waiver consisting of full benefits during preg13 nancy and throughout the 12-month 

14 postpartum period under title XIX).’’. 

15 (2) CONFORMING.—Section 2112(d)(2)(A) of 

16 the Social Security Act (42 U.S.C. 1397ll(d)(2)(A)) 

17 is amended by striking ‘‘the month in which the 60- 

18 day period’’ and all that follows through the period 

19 and inserting ‘‘the 12-month period beginning on the 

20 last day of the pregnancy.’’. 

21 (c) EFFECTIVE DATE.— 

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

23 the amendments made by this section shall take ef24 fect on the first day of the first calendar quarter 


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1 that begins on or after the date that is 1 year after 

2 the date of enactment of this Act. 

3 (2) EXCEPTION FOR STATE LEGISLATION.—In 

4 the case of a State plan under title XIX or XXI of 

5 the Social Security Act that the Secretary of Health 

6 and Human Services determines requires State legis7 lation in order for the respective plan to meet any 

8 requirement imposed by amendments made by this 

9 section, the plan shall not be regarded as failing to 

10 comply with the requirements of such title solely on 

11 the basis of its failure to meet such an additional re12 quirement before the first day of the first calendar 

13 quarter beginning after the close of the first regular 

14 session of the State legislature that begins after the 

15 date of enactment of this Act. For purposes of the 

16 previous sentence, in the case of a State that has a 

17 2-year legislative session, each year of the session 

18 shall be considered to be a separate regular session 

19 of the State legislature. 

20 SEC. 7. RELATIONSHIP TO OTHER LAWS. 

21 Nothing in this Act (or an amendment made by this 

22 Act) shall be construed to invalidate or limit the remedies, 

23 rights, and procedures of any Federal law or the law of 

24 any State or political subdivision of any State or jurisdic25 tion that provides greater or equal protection for enrollees 


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1 in a group health plan or group or individual health insur2 ance offered by a health insurance issuer. 

Æ 


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