I 

116TH CONGRESS 

1ST SESSION H. R. 2751 

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 15, 2019 

Ms. MOORE (for herself, Ms. HAALAND, 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 


kjohnson on DSK79L0C42 with BILLS
2 

•HR 2751 IH

1 average, there are 12.7 deaths per 100,000 live 

2 births for White women, 43.5 deaths per 100,000 

3 live births for African-American women, 32.5 deaths 

4 for American Indian and Alaskan Native women, 

5 and 14.4 deaths per 100,000 live births for women 

6 of other ethnicities. While maternal mortality dispar7 ately impacts African-American women and indige8 nous women, this urgent public health crisis tra9 verses race, ethnicity, socioeconomic status, edu10 cational 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) Many of these maternal deaths are likely 

15 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. 


kjohnson on DSK79L0C42 with BILLS
3 

•HR 2751 IH

1 (6) Midwives may practice in any setting, in2 cluding the home, community, hospitals, clinics, or 

3 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 (29), by striking ‘‘and’’ 

10 at the end; 

11 (B) by redesignating paragraph (30) as 

12 paragraph (31); and 

13 (C) by inserting after paragraph (29) the 

14 following new paragraph: 

15 ‘‘(30) services, including prenatal, delivery, and 

16 postpartum services, provided by doulas and mid17 wives (as those terms are defined in subsection (ff)) 

18 to the extent authorized under State law; and’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘(ff) DOULAS AND MIDWIVES DEFINED.—For pur22 poses of subsection (a)(30): 

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

24 means an individual who— 


kjohnson on DSK79L0C42 with BILLS
4 

•HR 2751 IH

1 ‘‘(A) is certified by an organization, which 

2 has been established for not less than five years 

3 and which requires the completion of continuing 

4 education to maintain such certification, to pro5 vide non-medical advice, information, emotional 

6 support, and physical comfort to an individual 

7 during such individual’s pregnancy, childbirth, 

8 and postpartum period; and 

9 ‘‘(B) maintains such certification by com10 pleting such required continuing education. 

11 ‘‘(2) MIDWIVES DEFINED.— 

12 ‘‘(A) IN GENERAL.—The term ‘midwife’ 

13 means a certified midwife, certified professional 

14 midwife, licensed midwife, and Tribal-recog15 nized midwife. 

16 ‘‘(B) CERTIFIED MIDWIFE.—For purposes 

17 of subparagraph (A), the term ‘certified mid18 wife’ means an individual who is certified by the 

19 American Midwifery Certification Board to 

20 practice midwifery. 

21 ‘‘(C) CERTIFIED PROFESSIONAL MID22 WIFE.—For purposes of subparagraph (A), the 

23 term ‘certified professional midwife’ means an 

24 individual who— 


kjohnson on DSK79L0C42 with BILLS
5 

•HR 2751 IH

1 ‘‘(i) is certified by the North Amer2 ican Registry of Midwives to practice mid3 wifery for normal, low-risk pregnancies and 

4 childbirths; 

5 ‘‘(ii) completes— 

6 ‘‘(I) a midwifery education pro7 gram accredited by the Midwifery 

8 Education and Accreditation Council 

9 or any other entity recognized by the 

10 Department of Education; or 

11 ‘‘(II) the requirements to obtain 

12 a Midwifery Bridge Certificate from 

13 the North American Registry of Mid14 wives; and 

15 ‘‘(iii) maintains the certification de16 scribed in clause (i) by completing any re17 quired continuing education for such cer18 tification. 

19 ‘‘(D) LICENSED MIDWIFE.—For purposes 

20 of subparagraph (A), the term ‘licensed mid21 wife’ means, with respect to a State, an indi22 vidual who is licensed under State law to prac23 tice midwifery. 

24 ‘‘(E) TRIBAL-RECOGNIZED MIDWIFE.—For 

25 purposes of subparagraph (A), the term ‘TribalVerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751

kjohnson on DSK79L0C42 with BILLS
6 

•HR 2751 IH

1 recognized midwife’ means an individual who is 

2 recognized by an Indian tribe (as defined in 

3 section 4 of the Indian Health Care Improve4 ment Act) to practice midwifery for such 

5 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 (29)’’ and 

10 inserting ‘‘(29), and (30)’’. 

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, 2020. 

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 

25 failure to meet such an additional requirement beVerDate Sep 11 2014 04:41 May 29, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2751.IH H2751

kjohnson on DSK79L0C42 with BILLS
7 

•HR 2751 IH

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 


kjohnson on DSK79L0C42 with BILLS