I 

117TH CONGRESS 

1ST SESSION H. R. 3126 

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 HOUSE OF REPRESENTATIVES 

MAY 11, 2021 

Mrs. WATSON COLEMAN (for herself, Ms. ADAMS, Ms. BASS, Mrs. BEATTY, 

Mr. BISHOP of Georgia, Mr. BLUMENAUER, Ms. BONAMICI, Mr. 

BRENDAN F. BOYLE of Pennsylvania, Mr. CARSON, Ms. CHU, Mr. 

COHEN, Mr. CONNOLLY, Mr. COOPER, Mr. ESPAILLAT, Mr. EVANS, Mr. 

FOSTER, Ms. LOIS FRANKEL of Florida, Mrs. HAYES, Mr. JOHNSON of 

Georgia, Mr. JONES, Mr. KILMER, Mr. LANGEVIN, Mr. LARSON of Connecticut, Ms. LEE of California, Mr. LEVIN of California, Mrs. CAROLYN

B. MALONEY of New York, Mr. MEEKS, Ms. MENG, Mr. MOULTON, Ms. 

NORTON, Mr. PAYNE, Mr. POCAN, Ms. ROSS, Ms. ROYBAL-ALLARD, Ms. 

SEWELL, Ms. SHERRILL, Mr. SMITH of Washington, Ms. STEVENS, Ms. 

STRICKLAND, Mr. SWALWELL, Ms. TLAIB, Mr. TORRES of New York, 

Ms. WASSERMAN SCHULTZ, Ms. WILSON of Florida, Mr. GARCI ́A of Illinois, and Ms. CASTOR of Florida) introduced the following bill; which was 

referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Ways and Means, Education and Labor, and Oversight and Reform, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Healthy Maternity and 

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

4 SEC. 2. FINDINGS AND PURPOSE. 

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

6 (1) Pregnancy is a significant life event for mil7 lions of women in the United States each year. 

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

9 through the Medicaid program, has recognized that 

10 pregnant women need immediate access to afford11 able care, and has allowed women who meet income12 eligibility requirements to enroll in Medicaid cov13 erage when they become pregnant. 

14 (3) Congress recognized the central importance 

15 of maternity coverage by classifying maternity and 

16 newborn care as one of the ten essential health bene17 fits that must now be covered on most individual 

18 and small group health insurance plans under sec19 tion 1302(b)(1) of the Patient Protection and Af20 fordable Care Act (42 U.S.C. 18022(b)(1)). 

21 (4) Congress has also recognized the significant 

22 challenge of maternal mortality and the need to 

23 eliminate disparities in maternal health outcomes for 

24 pregnancy-related and pregnancy-associated deaths, 

25 and to improve health outcomes for both mothers 


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1 and babies through passage of the Preventing Ma2 ternal Deaths Act of 2018 (Public Law 115–344). 

3 (5) Access to comprehensive maternity coverage 

4 allows women to access important pregnancy-related 

5 care, which is demonstrated to improve health out6 comes for women and newborns and reduce financial 

7 costs for both consumers and insurers. 

8 (6) Uninsured women, women with grand9 fathered and transitional health plans, self-funded 

10 student health plans, and catastrophic and high-de11 ductible health plans may lack access to comprehen12 sive and affordable maternity coverage. 

13 (7) Employer health plans that exclude depend14 ent daughters from maternity coverage leave young 

15 women without coverage for their pregnancy, even 

16 though Federal law has long held that treating preg17 nancy differently than other conditions is sex-based 

18 discrimination. 

19 (8) A special enrollment period is especially im20 portant for young adults, who are at high risk for 

21 unintended pregnancies, yet young adults are fre22 quently enrolled in catastrophic coverage, which 

23 often has fewer benefits, more restrictions, and high24 er deductibles. 


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1 (9) This coverage would be an equalizer for 

2 communities of color. The maternal mortality rate 

3 varies drastically by race and ethnicity, and where a 

4 woman lives. The rising maternal mortality rate in 

5 the United States is driven predominantly by the 

6 disproportionately high African-American maternal 

7 mortality rate, which is four times more than the 

8 rate for White women. 

9 (10) According to the Centers for Disease Con10 trol and Prevention, about 700 women die each year 

11 in the United States from pregnancy-related com12 plications. Black and American Indian/Alaska Native 

13 women are about three times more likely to die from 

14 a pregnancy-related cause than White women. 

15 (11) Data demonstrates that 3 in 5 pregnancy 

16 related deaths could be prevented. Improving access 

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

18 of race or ethnicity. 

19 (12) Timely maternity care improves the health 

20 of pregnant women, as well as birth outcomes and 

21 the health of babies throughout their lifetimes. Preg22 nancy-related maternal mortality is three to four 

23 times higher among women who receive no maternity 

24 care compared to women who do. Regular maternity 

25 care can detect or mitigate serious pregnancy-related 


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1 health complications, including preeclampsia, pla2 cental abruption, complications from diabetes, com3 plications from heart disease, and Graves’ disease, 

4 all of which can result in morbidity or mortality for 

5 the mother or newborn. 

6 (13) The Centers for Disease Control and Pre7 vention reports that more than half of all maternal 

8 deaths occur at delivery or in the first postpartum 

9 year, whereas just more than one-third of preg10 nancy-related or pregnancy-associated deaths occur 

11 while a person is still pregnant. Yet, for women eligi12 ble for the Medicaid program on the basis of preg13 nancy, such Medicaid coverage lapses at the end of 

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

15 (14) Timely maternity care and adequate 

16 postpartum care can reduce short- and long-term 

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

18 to affordable maternity care during her pregnancy, 

19 and she or her newborn experiences pregnancy com20 plications that result in health problems after birth, 

21 their insurer may end up paying much higher costs 

22 than if the insurer had covered the woman’s mater23 nity care during her pregnancy. Intensive maternity 

24 care can reduce hospital and neonatal intensive care 

25 unit admissions among infants, resulting in cost savVerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126

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1 ings of $1,768 to $5,560 per birth. For women with 

2 high-risk pregnancies, intensive maternity care saves 

3 $1.37 for every $1 invested in maternity care. 

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

5 the health of women and newborns by ensuring that all 

6 women eligible for coverage through the Exchanges estab7 lished under title I of the Patient Protection and Afford8 able Care Act (Public Law 111–148) and women eligible 

9 for other individual or group health plan coverage can ac10 cess affordable health coverage during their pregnancy. 

11 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 

12 FOR PREGNANT INDIVIDUALS. 

13 (a) PUBLIC HEALTH SERVICE ACT.—Section 

14 2702(b)(2) of the Public Health Service Act (42 U.S.C. 

15 300gg–1(b)(2)) is amended by inserting ‘‘including a spe16 cial enrollment period for pregnant individuals, beginning 

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

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

19 (b) PATIENT PROTECTION AND AFFORDABLE CARE

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

21 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend22 ed— 

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

24 the end; 


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1 (2) by redesignating subparagraph (D) as sub2 paragraph (E); and 

3 (3) by inserting after subparagraph (C) the fol4 lowing new subparagraph: 

5 ‘‘(D) a special enrollment period for preg6 nant individuals, beginning on the date on 

7 which the pregnancy is reported to the Ex8 change; and’’. 

9 (c) SPECIAL ENROLLMENT PERIODS.— 

10 (1) INTERNAL REVENUE CODE.—Section 

11 9801(f) of the Internal Revenue Code of 1986 (26 

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

13 the following new paragraph: 

14 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

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

16 employee who is eligible, but not enrolled, for 

17 coverage under the terms of the plan (or a de18 pendent of such an employee if the dependent 

19 is eligible, but not enrolled, for coverage under 

20 such terms) to enroll for coverage under the 

21 terms of the plan upon pregnancy, with the spe22 cial enrollment period beginning on the date on 

23 which the pregnancy is reported to the group 

24 health plan or the pregnancy is confirmed by a 

25 health care provider. 


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1 ‘‘(B) The Secretary shall promulgate regu2 lations with respect to the special enrollment 

3 period under subparagraph (A), including es4 tablishing a time period for pregnant individ5 uals to enroll in coverage and effective date of 

6 such coverage.’’. 

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

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

9 1181(f)) is amended by adding at the end the fol10 lowing: 

11 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

12 ‘‘(A) A group health plan or health insur13 ance issuer in connection with a group health 

14 plan shall permit an employee who is eligible, 

15 but not enrolled, for coverage under the terms 

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

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

18 coverage under such terms) to enroll for cov19 erage under the terms of the plan upon preg20 nancy, with the special enrollment period begin21 ning on the date on which the pregnancy is re22 ported to the group health plan or health insur23 ance issuer or the pregnancy is confirmed by a 

24 health care provider. 


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1 ‘‘(B) The Secretary shall promulgate regu2 lations with respect to the special enrollment 

3 period under subparagraph (A), including es4 tablishing a time period for pregnant individ5 uals to enroll in coverage and effective date of 

6 such coverage.’’. 

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

8 this section shall apply with respect to plan years begin9 ning after the 2021 plan year. 

10 SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 

11 CHILDREN. 

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

13 U.S.C. 300gg–19a) is amended— 

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

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

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

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

18 health plan, or health insurance issuer offering group or 

19 individual health insurance coverage, that provides cov20 erage for dependants shall ensure that such plan or cov21 erage includes coverage for maternity care associated with 

22 pregnancy, childbirth, and postpartum care for all partici23 pants, beneficiaries, or enrollees, including dependants, in24 cluding coverage of labor and delivery. Such coverage shall 

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


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1 SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

2 (a) COVERAGE OF PREGNANCY.— 

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

4 Personnel Management shall issue such regulations 

5 as are necessary to ensure that pregnancy is consid6 ered a change in family status and a qualifying life 

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

8 is not enrolled, in a health benefit plan under chap9 ter 89 title 5, United States Code. 

10 (2) EFFECTIVE DATE.—The requirement in 

11 paragraph (1) shall apply with respect to any con12 tract entered into under section 8902 of such title 

13 beginning 12 months after the date of enactment of 

14 this Act. 

15 (b) DESIGNATING CERTAIN FEHBP–RELATED

16 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI17 DEFICIENCY ACT.— 

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

19 United States Code, is amended by adding at the 

20 end the following: 

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

22 chapter relating to enrolling individuals in a health bene23 fits plan under this chapter, or changing the enrollment 

24 of an individual already so enrolled due to an event de25 scribed in section 5(a)(1) of the Healthy MOM Act, shall 

26 be deemed, for purposes of section 1342 of title 31, servVerDate Sep 11 2014 05:57 Jun 29, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3126.IH H3126

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1 ices for emergencies involving the safety of human life or 

2 the protection of property.’’. 

3 (2) APPLICATION.—The amendment made by 

4 paragraph (1) shall apply to any lapse in appropria5 tions beginning on or after the date of enactment of 

6 this Act. 

7 SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY 

8 STANDARD FOR PREGNANT INDIVIDUALS 

9 AND INFANTS. 

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

11 U.S.C. 1396a(l)(2)(A)) is amended— 

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

13 than 185 percent’’; 

14 (2) in clause (ii)— 

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

16 after the comma; 

17 (B) in subclause (II), by striking the pe18 riod at the end and inserting ‘‘, and’’; and 

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

20 ‘‘(III) January 1, 2022, is the percentage pro21 vided under clause (v).’’; and 

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

23 clause: 

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

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


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1 with respect to individuals described in subparagraph (A) 

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

3 ‘‘(I) the percentage specified for such individ4 uals by the State in an amendment to its State plan 

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

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

7 January 1, 2014, the percentage established for 

8 such individuals under the State’s authorizing legis9 lation or provided for under the State’s appropria10 tions as of that date.’’. 

11 SEC. 7. REQUIRING AND MAKING PERMANENT 12-MONTH 

12 CONTINUOUS COVERAGE FOR PREGNANT 

13 AND POSTPARTUM INDIVIDUALS UNDER 

14 MEDICAID AND CHIP. 

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

16 Act (42 U.S.C. 1396a) is amended— 

17 (1) in subsection (a)— 

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

19 at the end; 

20 (B) in paragraph (87), by striking the pe21 riod at the end and inserting ‘‘; and’’; and 

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

23 following new paragraph: 

24 ‘‘(88) provide that the State plan is in compli25 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 

5 women 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 woman (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. 8. 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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