II 

117TH CONGRESS 

1ST SESSION S. 3239 

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 

NOVEMBER 18, 2021 

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. MARKEY, Mr. KAINE, Ms. KLOBUCHAR, Mr. 

BOOKER, and Ms. ROSEN) 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’’. 


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1 SEC. 2. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 

2 FOR PREGNANT INDIVIDUALS. 

3 (a) PUBLIC HEALTH SERVICE ACT.—Section 

4 2702(b)(2) of the Public Health Service Act (42 U.S.C. 

5 300gg–1(b)(2)) is amended by inserting ‘‘including a spe6 cial enrollment period for pregnant individuals, beginning 

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

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

9 (b) PATIENT PROTECTION AND AFFORDABLE CARE

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

11 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend12 ed— 

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

14 the end; 

15 (2) by redesignating subparagraph (D) as sub16 paragraph (E); and 

17 (3) by inserting after subparagraph (C) the fol18 lowing new subparagraph: 

19 ‘‘(D) a special enrollment period for preg20 nant individuals, beginning on the date on 

21 which the pregnancy is reported to the Ex22 change; and’’. 

23 (c) SPECIAL ENROLLMENT PERIODS.— 

24 (1) INTERNAL REVENUE CODE.—Section 

25 9801(f) of the Internal Revenue Code of 1986 (26 


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

2 the following new paragraph: 

3 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

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

5 shall permit an employee who is eligible, but 

6 not enrolled, for coverage under the terms of 

7 the plan (or a dependent of such an employee 

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

9 coverage under such terms) to enroll for cov10 erage under the terms of the plan upon preg11 nancy, with the special enrollment period begin12 ning on the date on which the pregnancy is re13 ported to the group health plan or the preg14 nancy is confirmed by a health care provider. 

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

16 promulgate regulations with respect to the spe17 cial enrollment period under subparagraph (A), 

18 including establishing a time period for preg19 nant individuals to enroll in coverage and effec20 tive date of such coverage.’’. 

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

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

23 1181(f)) is amended by adding at the end the fol24 lowing: 

25 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 


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

2 or health insurance issuer in connection with a 

3 group health plan shall permit an employee who 

4 is eligible, but not enrolled, for coverage under 

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

6 an employee if the dependent is eligible, but not 

7 enrolled, for coverage under such terms) to en8 roll for coverage under the terms of the plan 

9 upon pregnancy, with the special enrollment pe10 riod beginning on the date on which the preg11 nancy is reported to the group health plan or 

12 health insurance issuer or the pregnancy is con13 firmed by a health care provider. 

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

15 promulgate regulations with respect to the spe16 cial enrollment period under subparagraph (A), 

17 including establishing a time period for preg18 nant individuals to enroll in coverage and effec19 tive date of such coverage.’’. 

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

21 this section shall apply with respect to plan years begin22 ning after the 2021 plan year. 


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1 SEC. 3. COVERAGE OF MATERNITY CARE FOR DEPENDENT 

2 CHILDREN. 

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

4 U.S.C. 300gg–19a) is amended— 

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

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

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

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

9 health plan, or health insurance issuer offering group or 

10 individual health insurance coverage, that provides cov11 erage for dependents shall ensure that such plan or cov12 erage includes coverage for maternity care associated with 

13 pregnancy, childbirth, and postpartum care for all partici14 pants, beneficiaries, or enrollees, including dependents, in15 cluding coverage of labor and delivery. Such coverage shall 

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

17 SEC. 4. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

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

19 Office of Personnel Management shall issue such regula20 tions as are necessary to ensure that pregnancy is consid21 ered a change in family status and a qualifying life event 

22 for an individual who is eligible to enroll, but is not en23 rolled, in a health benefit plan under chapter 89 of title 

24 5, United States Code. 

25 (b) EFFECTIVE DATE.—The requirement in sub26 section (a) shall apply with respect to any contract entered 


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1 into under section 8902 of such title beginning 12 months 

2 after the date of enactment of this Act. 

3 SEC. 5. CONTINUATION OF MEDICAID INCOME ELIGIBILITY 

4 STANDARD FOR PREGNANT INDIVIDUALS 

5 AND INFANTS. 

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

7 U.S.C. 1396a(l)(2)(A)) is amended— 

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

9 than 185 percent’’; 

10 (2) in clause (ii)— 

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

12 after the comma; 

13 (B) in subclause (II), by striking the pe14 riod at the end and inserting ‘‘, and’’; and 

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

16 ‘‘(III) January 1, 2022, is the percentage pro17 vided under clause (v).’’; and 

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

19 clause: 

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

21 medical assistance provided on or after January 1, 2022, 

22 with respect to individuals described in subparagraph (A) 

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


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1 ‘‘(I) the percentage specified for such individ2 uals by the State in an amendment to its State plan 

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

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

5 January 1, 2014, the percentage established for 

6 such individuals under the State’s authorizing legis7 lation or provided for under the State’s appropria8 tions as of that date.’’. 

9 SEC. 6. REQUIRING AND MAKING PERMANENT 12-MONTH 

10 CONTINUOUS COVERAGE FOR PREGNANT 

11 AND POSTPARTUM INDIVIDUALS UNDER 

12 MEDICAID AND CHIP. 

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

14 Act (42 U.S.C. 1396a) is amended— 

15 (1) in subsection (a)— 

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

17 at the end; 

18 (B) in paragraph (87), by striking the pe19 riod at the end and inserting ‘‘; and’’; and 

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

21 following new paragraph: 

22 ‘‘(88) provide that the State plan is in compli23 ance with subsection (e)(16).’’; and 


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1 (2) in subsection (e)(16), as added by section 

2 9812 of the American Rescue Plan Act of 2021 

3 (Public Law 117–2)— 

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

5 the option of the State, the State plan (or waiv6 er of such State plan) may provide’’ and insert7 ing ‘‘A State plan (or waiver of such State 

8 plan) shall provide’’; 

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

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

11 making an election under this paragraph’’ and 

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

13 such State plan)’’; and 

14 (C) by striking subparagraph (C). 

15 (b) CHIP.— 

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

17 Social Security Act (42 U.S.C. 1397gg(e)(1)(J)), as 

18 inserted by section 9822 of the American Rescue 

19 Plan Act of 2021 (Public Law 117–2), is amended 

20 to read as follows: 

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

22 1902(e) (relating to the requirement to provide 

23 medical assistance under the State plan or 

24 waiver consisting of full benefits during preg25 nancy and throughout the 12-month 


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1 postpartum period under title XIX) such that 

2 the provision of assistance under the State child 

3 health plan or waiver for targeted low-income 

4 children or targeted low-income pregnant indi5 viduals during pregnancy and the 12-month 

6 postpartum period shall be required and shall 

7 include coverage of all items or services pro8 vided to a targeted low-income child or targeted 

9 low-income pregnant individual (as applicable) 

10 under the State child health plan or waiver).’’. 

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

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

13 as inserted by section 9822 of the American Rescue 

14 Plan Act of 2021 (Public Law 117–2), is amended 

15 by striking ‘‘the month in which the 60-day period’’ 

16 and all that follows through ‘‘pursuant to section 

17 2107(e)(1),’’. 

18 (c) CONFORMING AMENDMENTS.— 

19 (1) Section 9812(b) of the American Rescue 

20 Plan Act of 2021 (Public Law 117–2) is amended 

21 to read as follows: 

22 ‘‘(b) EFFECTIVE DATE.— 

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

24 the amendment made by subsection (a) shall apply 

25 with respect to services furnished on or after the 1st 


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1 day of the 1st fiscal year quarter that begins one 

2 year after the date of the enactment of this Act. 

3 ‘‘(2) EXCEPTION FOR STATE LEGISLATION.—In 

4 the case of a State plan under title XIX of the So5 cial Security Act that the Secretary of Health and 

6 Human Services determines requires State legisla7 tion in order for the respective plan to meet any re8 quirement 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 fiscal year 

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 (2) Section 9822(b) of the American Rescue 

21 Plan Act of 2021 (Public Law 117–2) is amended 

22 to read as follows: 

23 ‘‘(b) EFFECTIVE DATE.— 

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

25 the amendments made by subsection (a), shall apply 


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1 with respect to services furnished on or after the 1st 

2 day of the 1st fiscal year quarter that begins one 

3 year after the date of the enactment of this Act. 

4 ‘‘(2) EXCEPTION FOR STATE LEGISLATION.—In 

5 the case of a State child health plan under title XXI 

6 of the Social Security Act that the Secretary of 

7 Health and Human Services determines requires 

8 State legislation in order for the plan to meet any 

9 requirement imposed by amendments made by this 

10 section, the respective plan shall not be regarded as 

11 failing to comply with the requirements of such title 

12 solely on the basis of its failure to meet such an ad13 ditional requirement before the first day of the first 

14 fiscal year quarter beginning after the close of the 

15 first regular session of the State legislature that be16 gins after the date of enactment of this Act. For 

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

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

19 of the session shall be considered to be a separate 

20 regular session of the State legislature.’’. 

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

22 subsections (a) and (c)(1) shall take effect as if included 

23 in the enactment of section 9812 of the American Rescue 

24 Plan Act of 2021 (Public Law 117–2). The amendments 


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1 made by subsections (b) and (c)(2) shall take effect as 

2 if included in the enactment of section 9822 of such Act. 

3 SEC. 7. RELATIONSHIP TO OTHER LAWS. 

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

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

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

7 any State or political subdivision of any State or jurisdic8 tion that provides greater or equal protection for enrollees 

9 in a group health plan or group or individual health insur10 ance offered by a health insurance issuer. 

Æ 


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