II 

117TH CONGRESS 

2D SESSION S. 4100 

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 SENATE OF THE UNITED STATES 

APRIL 27, 2022 

Ms. WARREN (for herself, Mr. BOOKER, Mr. CASEY, Mr. PADILLA, Mr. SANDERS, Ms. DUCKWORTH, and Mr. BLUMENTHAL) introduced the following 

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

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 


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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. 


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1 (6) Midwives may practice in any setting, in2 cluding the home, community, hospitals, birth cen3 ters, clinics, or 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 (30), by striking ‘‘and’’ 

10 at the end; 

11 (B) by redesignating paragraph (31) as 

12 paragraph (32); and 

13 (C) by inserting after paragraph (30) the 

14 following new paragraph: 

15 ‘‘(31) services and care, including prenatal, de16 livery, and postpartum care, that is provided in a 

17 culturally congruent manner (as defined in sub18 section (kk)) by doulas, midwives, and tribal mid19 wives (as those terms are defined in subsection (jj)), 

20 that is provided in the home, community, a hospital, 

21 birth center, clinic, health unit, or is furnished via 

22 telehealth to the extent authorized under State law; 

23 and’’; and 

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


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1 ‘‘(jj) DOULAS, MIDWIVES, AND TRIBAL MIDWIFE

2 DEFINED.—For purposes of subsection (a)(31): 

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

4 means an individual who— 

5 ‘‘(A) has completed 60 hours of 

6 foundational training; 

7 ‘‘(B) is certified by an organization, which 

8 has been established for not less than five years 

9 and which requires the completion of continuing 

10 education to maintain such certification, to pro11 vide non-medical advice, information, emotional 

12 support, and physical comfort to an individual 

13 during such individual’s pregnancy, childbirth, 

14 and postpartum period; and 

15 ‘‘(C) maintains such certification by com16 pleting such required continuing education. 

17 ‘‘(2) MIDWIVES DEFINED.—The term ‘midwife’ 

18 means a midwife who meets at a minimum the inter19 national definition of the midwife and global stand20 ards for midwifery education as established by the 

21 International Confederation of Midwives. 

22 ‘‘(3) TRIBAL MIDWIFE DEFINED.—The term 

23 ‘tribal midwife’ means an individual who is recog24 nized by an Indian tribe (as defined in section 4 of 


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1 the Indian Health Care Improvement Act (25 U.S.C. 

2 1603)) to practice midwifery for such tribe. 

3 ‘‘(kk) CULTURALLY CONGRUENT CARE DEFINED.— 

4 For purposes of subsection (a)(31), the term ‘culturally 

5 congruent care’, with respect to maternity care, means 

6 care that is provided in agreement with the preferred cul7 tural values, beliefs, worldview, language, and practices of 

8 the health care consumer and other stakeholders.’’. 

9 (b) REQUIRING MANDATORY COVERAGE UNDER

10 STATE PLAN.—Section 1902(a)(10)(A) of the Social Se11 curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 

12 matter preceding clause (i), by striking ‘‘and (30)’’ and 

13 inserting ‘‘(30), and (31)’’. 

14 (c) CONFORMING AMENDMENTS.— 

15 (1) Section 1902(nn)(3) of the Social Security 

16 Act (42 U.S.C. 1396a(nn)(3)) is amended by strik17 ing ‘‘(30)’’ and inserting ‘‘(32)’’. 

18 (2) Section 1905(a) of the Social Security Act 

19 (42 U.S.C. 1396d(a)) is amended, in the 5th sen20 tence, by striking ‘‘(30)’’ and inserting ‘‘(32)’’. 

21 (d) EFFECTIVE DATE.— 

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

23 the amendments made by this section shall apply 

24 with respect to medical assistance furnished on or 

25 after January 1, 2022. 


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1 (2) EXCEPTION FOR STATE LEGISLATION.—In 

2 the case of a State plan under title XIX of the So3 cial Security Act (42 U.S.C. 1396 et seq.) that the 

4 Secretary of Health and Human Services determines 

5 requires State legislation in order for the respective 

6 plan to meet any requirement imposed by amend7 ments made by this section, the respective plan shall 

8 not be regarded as failing to comply with the re9 quirements of such title solely on the basis of its 

10 failure to meet such an additional requirement be11 fore the first day of the first calendar quarter begin12 ning after the close of the first regular session of the 

13 State legislature that begins after the date of the en14 actment of this Act. For purposes of the previous 

15 sentence, in the case of a State that has a 2-year 

16 legislative session, each year of the session shall be 

17 considered to be a separate regular session of the 

18 State legislature. 

Æ 


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