II 

116TH CONGRESS 

1ST SESSION S. 1481 

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

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

IN THE SENATE OF THE UNITED STATES 

MAY 15, 2019 

Mr. BROWN (for himself, Ms. SMITH, Mrs. GILLIBRAND, Mr. MARKEY, Ms. 

KLOBUCHAR, Mr. TESTER, Ms. HASSAN, Mr. BLUMENTHAL, Ms. HARRIS, Mr. CASEY, Mr. WHITEHOUSE, Mr. BOOKER, Mr. MERKLEY, Mr. 

PETERS, Mr. KING, Ms. ROSEN, Mr. LEAHY, Ms. CORTEZ MASTO, Ms. 

BALDWIN, Mr. JONES, and Mr. KAINE) 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 

women, 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. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 


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1 (1) Pregnancy is a significant life event for mil2 lions of women in the United States each year. 

3 (2) For more than 30 years, our Nation, 

4 through the Medicaid program, has recognized that 

5 pregnant women need immediate access to afford6 able care, and has allowed women who meet income7 eligibility requirements to enroll in Medicaid cov8 erage when they become pregnant. 

9 (3) Congress recognized the central importance 

10 of maternity coverage by classifying maternity and 

11 newborn care as one of the ten essential health bene12 fits that must now be covered on most individual 

13 and small group health insurance plans under sec14 tion 1302(b)(1) of the Patient Protection and Af15 fordable Care Act (42 U.S.C. 18022(b)(1)). 

16 (4) Congress has also recognized the significant 

17 challenge of maternal mortality and the need to 

18 eliminate disparities in maternal health outcomes for 

19 pregnancy-related and pregnancy-associated deaths, 

20 and to improve health outcomes for both mothers 

21 and babies through passage of the Preventing Ma22 ternal Deaths Act of 2018 (Public Law 115–344). 

23 (5) Access to comprehensive maternity coverage 

24 allows women to access important pregnancy-related 

25 care, which is demonstrated to improve health outVerDate Sep 11 2014 02:23 May 25, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1481.IS S1481

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1 comes for women and newborns and reduce financial 

2 costs for both consumers and insurers. 

3 (6) Uninsured women, women with grand4 fathered and transitional health plans, self-funded 

5 student health plans, and catastrophic and high-de6 ductible health plans may lack access to comprehen7 sive and affordable maternity coverage. 

8 (7) Employer health plans that exclude depend9 ent daughters from maternity coverage leave young 

10 women without coverage for their pregnancy, even 

11 though Federal law has long held that treating preg12 nancy differently than other conditions is sex-based 

13 discrimination. 

14 (8) A special enrollment period is especially im15 portant for young adults, who are at high risk for 

16 unintended pregnancies, yet young adults are fre17 quently enrolled in catastrophic coverage, which 

18 often has fewer benefits, more restrictions, and high19 er deductibles. 

20 (9) This coverage would be an equalizer for 

21 communities of color. The maternal mortality rate 

22 varies drastically by race and ethnicity, and where a 

23 woman lives. The rising maternal mortality rate in 

24 the United States is driven predominantly by the 

25 disproportionately high African-American maternal 


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1 mortality rate, which is four times more than the 

2 rate for White women. 

3 (10) According to the Centers for Disease Con4 trol and Prevention, about 700 women die each year 

5 in the United States from pregnancy-related com6 plications. Black and American Indian/Alaska Native 

7 women are about three times more likely to die from 

8 a pregnancy-related cause than White women. 

9 (11) Data demonstrates that 3 in 5 pregnancy10 related deaths could be prevented. Improving access 

11 to care is one way to help prevent deaths, regardless 

12 of race or ethnicity. 

13 (12) Timely maternity care improves the health 

14 of pregnant women, as well as birth outcomes and 

15 the health of babies throughout their lifetimes. Preg16 nancy-related maternal mortality is three to four 

17 times higher among women who receive no maternity 

18 care compared to women who do. Regular maternity 

19 care can detect or mitigate serious pregnancy-related 

20 health complications, including preeclampsia, pla21 cental abruption, complications from diabetes, com22 plications from heart disease, and Graves’ disease, 

23 all of which can result in morbidity or mortality for 

24 the mother or newborn. 


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1 (13) The Centers for Disease Control and Pre2 vention reports that more than half of all maternal 

3 deaths occur at delivery or in the first postpartum 

4 year, whereas just more than one-third of preg5 nancy-related or pregnancy-associated deaths occur 

6 while a person is still pregnant. Yet, for women eligi7 ble for the Medicaid program on the basis of preg8 nancy, such Medicaid coverage lapses at the end of 

9 the month on which the 60th postpartum day lands. 

10 (14) Timely maternity care and adequate 

11 postpartum care can reduce short- and long-term 

12 health care costs. If a woman does not have access 

13 to affordable maternity care during her pregnancy, 

14 and she or her newborn experiences pregnancy com15 plications that result in health problems after birth, 

16 their insurer may end up paying much higher costs 

17 than if the insurer had covered the woman’s mater18 nity care during her pregnancy. Intensive maternity 

19 care can reduce hospital and neonatal intensive care 

20 unit admissions among infants, resulting in cost sav21 ings of $1,768 to $5,560 per birth. For women with 

22 high-risk pregnancies, intensive maternity care saves 

23 $1.37 for every $1 invested in maternity care. 

24 (b) PURPOSE.—The purpose of this Act is to protect 

25 the health of women and newborns by ensuring that all 


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1 women eligible for coverage through the Exchanges estab2 lished under title I of the Patient Protection and Afford3 able Care Act (Public Law 111–148) and women eligible 

4 for other individual or group health plan coverage can ac5 cess affordable health coverage during their pregnancy. 

6 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 

7 FOR PREGNANT INDIVIDUALS. 

8 (a) PUBLIC HEALTH SERVICE ACT.—Section 

9 2702(b)(2) of the Public Health Service Act (42 U.S.C. 

10 300gg–1(b)(2)) is amended by inserting ‘‘including a spe11 cial enrollment period for pregnant individuals, beginning 

12 on the date on which the pregnancy is reported to the 

13 health insurance issuer’’ before the period at the end. 

14 (b) PATIENT PROTECTION AND AFFORDABLE CARE

15 ACT.—Section 1311(c)(6) of the Patient Protection and 

16 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend17 ed— 

18 (1) in subparagraph (C), by striking ‘‘and’’ at 

19 the end; 

20 (2) by redesignating subparagraph (D) as sub21 paragraph (E); and 

22 (3) by inserting after subparagraph (C) the fol23 lowing new subparagraph: 

24 ‘‘(D) a special enrollment period for preg25 nant individuals, beginning on the date on 


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1 which the pregnancy is reported to the Ex2 change; and’’. 

3 (c) SPECIAL ENROLLMENT PERIODS.— 

4 (1) INTERNAL REVENUE CODE.—Section 

5 9801(f) of the Internal Revenue Code of 1986 (26 

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

7 the following new paragraph: 

8 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

9 ‘‘(A) A group health plan shall permit an 

10 employee who is eligible, but not enrolled, for 

11 coverage under the terms of the plan (or a de12 pendent of such an employee if the dependent 

13 is eligible, but not enrolled, for coverage under 

14 such terms) to enroll for coverage under the 

15 terms of the plan upon pregnancy, with the spe16 cial enrollment period beginning on the date on 

17 which the pregnancy is reported to the group 

18 health plan or the pregnancy is confirmed by a 

19 health care provider. 

20 ‘‘(B) The Secretary shall promulgate regu21 lations with respect to the special enrollment 

22 period under subparagraph (A), including es23 tablishing a time period for pregnant individ24 uals to enroll in coverage and effective date of 

25 such coverage.’’. 


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1 (2) ERISA.—Section 701(f) of the Employee 

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

3 1181(f)) is amended by adding at the end the fol4 lowing: 

5 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

6 ‘‘(A) A group health plan or health insur7 ance issuer in connection with a group health 

8 plan shall permit an employee who is eligible, 

9 but not enrolled, for coverage under the terms 

10 of the plan (or a dependent of such an employee 

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

12 coverage under such terms) to enroll for cov13 erage under the terms of the plan upon preg14 nancy, with the special enrollment period begin15 ning on the date on which the pregnancy is re16 ported to the group health plan or health insur17 ance issuer or the pregnancy is confirmed by a 

18 health care provider. 

19 ‘‘(B) The Secretary shall promulgate regu20 lations with respect to the special enrollment 

21 period under subparagraph (A), including es22 tablishing a time period for pregnant individ23 uals to enroll in coverage and effective date of 

24 such coverage.’’. 


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1 (d) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply with respect to plan years begin3 ning after the 2019 plan year. 

4 SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 

5 CHILDREN. 

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

7 U.S.C. 300gg–19a) is amended by adding at the end the 

8 following: 

9 ‘‘(e) COVERAGE OF MATERNITY CARE.—A group 

10 health plan, or health insurance issuer offering group or 

11 individual health insurance coverage, that provides cov12 erage for dependents shall ensure that such plan or cov13 erage includes coverage for maternity care associated with 

14 pregnancy, childbirth, and postpartum care for all partici15 pants, beneficiaries, or enrollees, including dependents, in16 cluding coverage of labor and delivery. Such coverage shall 

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

18 SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

19 (a) COVERAGE OF PREGNANCY.— 

20 (1) IN GENERAL.—The Director of the Office of 

21 Personnel Management shall issue such regulations 

22 as are necessary to ensure that pregnancy is consid23 ered a change in family status and a qualifying life 

24 event for an individual who is eligible to enroll, but 


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1 is not enrolled, in a health benefit plan under chap2 ter 89 title 5, United States Code. 

3 (2) EFFECTIVE DATE.—The requirement in 

4 paragraph (1) shall apply with respect to any con5 tract entered into under section 8902 of such title 

6 beginning 12 months after the date of enactment of 

7 this Act. 

8 (b) DESIGNATING CERTAIN FEHBP-RELATED

9 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI10 DEFICIENCY ACT.— 

11 (1) IN GENERAL.—Section 8905 of title 5, 

12 United States Code, is amended by adding at the 

13 end the following: 

14 ‘‘(i) Any services by an officer or employee under this 

15 chapter relating to enrolling individuals in a health bene16 fits plan under this chapter, or changing the enrollment 

17 of an individual already so enrolled due to an event de18 scribed in section 5(a)(1) of the Healthy MOM Act, shall 

19 be deemed, for purposes of section 1342 of title 31, serv20 ices for emergencies involving the safety of human life or 

21 the protection of property.’’. 

22 (2) APPLICATION.—The amendment made by 

23 paragraph (1) shall apply to any lapse in appropria24 tions beginning on or after the date of enactment of 

25 this Act. 


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1 SEC. 6. 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, 2020, 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, 2020, 

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. 7. 12-MONTH CONTINUOUS COVERAGE FOR PREG5 NANT AND POSTPARTUM INDIVIDUALS 

6 UNDER MEDICAID AND CHIP. 

7 (a) MEDICAID.— 

8 (1) REQUIRED FOR ALL ELIGIBILITY PATH9 WAYS.—Paragraph (5) of section 1902(e) of the So10 cial Security Act (42 U.S.C. 1396a(e)) is amended 

11 to read as follows: 

12 ‘‘(5) Any individual who is eligible for medical assist13 ance under the State plan or a waiver of such plan and 

14 who is, or who while so eligible becomes, pregnant, shall 

15 continue to be eligible under the plan or waiver for medical 

16 assistance that provides at least essential health benefits 

17 as described in section 1302(b) of the Patient Protection 

18 and Affordable Care Act, through the end of the month 

19 in which the 1-year period (beginning on the last day of 

20 her pregnancy) ends, regardless of the basis for the indi21 vidual’s eligibility for medical assistance, including if the 

22 individual’s eligibility for medical assistance is on the basis 

23 of being pregnant.’’. 


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1 (2) CONFORMING AMENDMENTS.—Title XIX of 

2 the Social Security Act (42 U.S.C. 1396 et seq.) is 

3 amended— 

4 (A) in section 1902— 

5 (i) in subsection (a)(10), in the mat6 ter following subparagraph (G) by striking 

7 ‘‘(VII) the medical assistance’’ and all that 

8 follows through ‘‘complicate pregnancy,’’; 

9 (ii) in subsection (e)(6), by striking 

10 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

11 (iii) in subsection (l)(1)(A), by strik12 ing ‘‘60-day’’ and inserting ‘‘1-year’’; 

13 (B) in section 1903(v)(4)(A)(i), by striking 

14 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

15 (C) in section 1905(a), in the 4th sentence 

16 in the matter following paragraph (30), by 

17 striking ‘‘60-day’’ and inserting ‘‘1-year’’. 

18 (b) CHIP.— 

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

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

21 amended— 

22 (A) by redesignating subparagraphs (H) 

23 through (S) as subparagraphs (I) through (T), 

24 respectively; and 


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1 (B) by inserting after subparagraph (G), 

2 the following: 

3 ‘‘(H) Section 1902(e)(5) (requiring 12- 

4 month continuous coverage for pregnant indi5 viduals).’’. 

6 (2) CONFORMING AMENDMENTS.—Subsections 

7 (d)(2)(A) and (f)(2) of section 2112 of the Social 

8 Security Act (42 U.S.C. 1397ll) are each amended 

9 by striking ‘‘60-day’’ and inserting ‘‘1-year’’. 

10 (c) EFFECTIVE DATE.— 

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

12 the amendments made by this section shall take ef13 fect on the 1st day of the 1st calendar quarter that 

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

15 date of enactment of this Act. 

16 (2) EXCEPTION FOR STATE LEGISLATION.—In 

17 the case of a State plan under title XIX of the So18 cial Security Act or a State child health plan under 

19 title XXI of such Act that the Secretary of Health 

20 and Human Services determines requires State legis21 lation in order for the respective plan to meet any 

22 requirement imposed by amendments made by this 

23 section, the respective plan shall not be regarded as 

24 failing to comply with the requirements of such title 

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1 ditional requirement before the first day of the first 

2 calendar quarter beginning after the close of the 

3 first regular session of the State legislature that be4 gins after the date of enactment of this Act. For 

5 purposes of the previous sentence, in the case of a 

6 State that has a 2-year legislative session, each year 

7 of the session shall be considered to be a separate 

8 regular session of the State legislature. 

9 SEC. 8. RELATIONSHIP TO OTHER LAWS. 

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

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

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

13 any State or political subdivision of any State or jurisdic14 tion that provides greater or equal protection for enrollees 

15 in a group health plan or group or individual health insur16 ance offered by a health insurance issuer. 

Æ 


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