Healthy MOM Act

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. Short title This Act may be cited as the Healthy Maternity and Obstetric Medicine Act Healthy MOM Act 2. Providing for a special enrollment period for pregnant individuals (a) Public Health Service Act Section 2702(b)(2) of the Public Health Service Act ( 42 U.S.C. 300gg–1(b)(2) including a special enrollment period for pregnant individuals, beginning on the date on which the pregnancy is reported to the health insurance issuer (b) Patient protection and affordable care act Section 1311(c)(6) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(c)(6) (1) in subparagraph (C), by striking and (2) by redesignating subparagraph (D) as subparagraph (E); and (3) by inserting after subparagraph (C) the following new subparagraph: (D) a special enrollment period for pregnant individuals, beginning on the date on which the pregnancy is reported to the Exchange; and . (c) Special enrollment periods (1) Internal Revenue Code Section 9801(f) 26 U.S.C. 9801(f) (4) For pregnant individuals (A) In general A group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan upon pregnancy, with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or the pregnancy is confirmed by a health care provider. (B) Regulations The Secretary shall promulgate regulations with respect to the special enrollment period under subparagraph (A), including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage. . (2) ERISA Section 701(f) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1181(f) (4) For pregnant individuals (A) In general A group health plan or health insurance issuer in connection with a group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan upon pregnancy, with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or health insurance issuer or the pregnancy is confirmed by a health care provider. (B) Regulations The Secretary shall promulgate regulations with respect to the special enrollment period under subparagraph (A), including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage. . (d) Effective date The amendments made by this section shall apply with respect to plan years beginning after the 2021 plan year. 3. Coverage of maternity care for dependent children Section 2719A of the Public Health Service Act ( 42 U.S.C. 300gg–19a (1) in subsection (e), by inserting (other than subsection (f)) this section (2) by adding at the end the following: (f) Coverage of maternity care A group health plan, or health insurance issuer offering group or individual health insurance coverage, that provides coverage for dependents shall ensure that such plan or coverage includes coverage for maternity care associated with pregnancy, childbirth, and postpartum care for all participants, beneficiaries, or enrollees, including dependents, including coverage of labor and delivery. Such coverage shall be provided to all pregnant dependents regardless of age. . 4. Federal employee health benefit plans (a) Coverage of pregnancy The Director of the Office of Personnel Management shall issue such regulations as are necessary to ensure that pregnancy is considered a change in family status and a qualifying life event for an individual who is eligible to enroll, but is not enrolled, in a health benefit plan under chapter 89 (b) Effective date The requirement in subsection (a) shall apply with respect to any contract entered into under section 8902 of such title beginning 12 months after the date of enactment of this Act. 5. Continuation of Medicaid income eligibility standard for pregnant individuals and infants Section 1902(l)(2)(A) of the Social Security Act ( 42 U.S.C. 1396a(l)(2)(A) (1) in clause (i), by striking and not more than 185 percent (2) in clause (ii)— (A) in subclause (I), by striking and (B) in subclause (II), by striking the period at the end and inserting , and (C) by adding at the end the following: (III) January 1, 2022, is the percentage provided under clause (v). ; and (3) by adding at the end the following new clause: (v) The percentage provided under clause (ii) for medical assistance provided on or after January 1, 2022, with respect to individuals described in subparagraph (A) or (B) of paragraph (1) shall not be less than— (I) the percentage specified for such individuals by the State in an amendment to its State plan (whether approved or not) as of January 1, 2014; or (II) if no such percentage is specified as of January 1, 2014, the percentage established for such individuals under the State's authorizing legislation or provided for under the State's appropriations as of that date. . 6. Requiring and making permanent 12-month continuous coverage for pregnant and postpartum individuals under Medicaid and CHIP (a) Medicaid Section 1902 of the Social Security Act ( 42 U.S.C. 1396a (1) in subsection (a)— (A) in paragraph (86), by striking and (B) in paragraph (87), by striking the period at the end and inserting ; and (C) by inserting after paragraph (87) the following new paragraph: (88) provide that the State plan is in compliance with subsection (e)(16). ; and (2) in subsection (e)(16), as added by section 9812 of the American Rescue Plan Act of 2021 ( Public Law 117–2 (A) in subparagraph (A), by striking At the option of the State, the State plan (or waiver of such State plan) may provide A State plan (or waiver of such State plan) shall provide (B) in subparagraph (B), in the matter preceding clause (i), by striking by a State making an election under this paragraph under a State plan (or a waiver of such State plan) (C) by striking subparagraph (C). (b) CHIP (1) In general Section 2107(e)(1)(J) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1)(J) Public Law 117–2 (J) Paragraphs (5) and (16) of section 1902(e) (relating to the requirement to provide medical assistance under the State plan or waiver consisting of full benefits during pregnancy and throughout the 12-month postpartum period under title XIX) such that the provision of assistance under the State child health plan or waiver for targeted low-income children or targeted low-income pregnant individuals during pregnancy and the 12-month postpartum period shall be required and shall include coverage of all items or services provided to a targeted low-income child or targeted low-income pregnant individual (as applicable) under the State child health plan or waiver). . (2) Conforming Section 2112(d)(2)(A) of the Social Security Act ( 42 U.S.C. 1397ll(d)(2)(A) Public Law 117–2 the month in which the 60-day period pursuant to section 2107(e)(1), (c) Conforming amendments (1) Section 9812(b) of the American Rescue Plan Act of 2021 ( Public Law 117–2 (b) Effective date (1) In general Subject to paragraph (2), the amendment made by subsection (a) shall apply with respect to services furnished on or after the 1st day of the 1st fiscal year quarter that begins one year after the date of the enactment of this Act. (2) Exception for State legislation In the case of a State plan under title XIX of the Social Security Act that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by amendments made by this section, the plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first fiscal year quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature. . (2) Section 9822(b) of the American Rescue Plan Act of 2021 ( Public Law 117–2 (b) Effective date (1) In general Subject to paragraph (2), the amendments made by subsection (a), shall apply with respect to services furnished on or after the 1st day of the 1st fiscal year quarter that begins one year after the date of the enactment of this Act. (2) Exception for State legislation In the case of a State child health plan under title XXI of the Social Security Act that the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet any requirement imposed by amendments made by this section, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first fiscal year quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature. . (d) Effective date The amendments made by subsections (a) and (c)(1) shall take effect as if included in the enactment of section 9812 of the American Rescue Plan Act of 2021 ( Public Law 117–2 7. Relationship to other laws Nothing in this Act (or an amendment made by this Act) shall be construed to invalidate or limit the remedies, rights, and procedures of any Federal law or the law of any State or political subdivision of any State or jurisdiction that provides greater or equal protection for enrollees in a group health plan or group or individual health insurance offered by a health insurance issuer.

Summary: Healthy Maternity and Obstetric Medicine Act or the Healthy MOM Act This bill expands health insurance coverage availability for pregnant individuals. It requires health insurers, health insurance exchanges, and group health plans to offer a special enrollment period to pregnant individuals. The special enrollment period offered by an insurer or exchange must begin when the pregnancy is reported to the insurer or exchange. The special enrollment period offered by a group health plan must begin when the pregnancy is reported to the plan or is confirmed by a health care provider. The bill also makes pregnancy a qualifying life event for the purpose of enrolling in a federal employee health benefit plan. Additionally, a group health plan or health insurer that covers dependents must provide coverage for maternity care to all covered individuals. Any individual who is eligible for Medicaid and is, or becomes, pregnant maintains such eligibility for one year after the end of the pregnancy. The bill revises the range in which a state must establish a maximum level of family income for pregnant women and infants to be eligible for Medicaid. The upper limit of the range is eliminated and the lower limit is set to the level in place on January 1, 2014.