I 
117TH CONGRESS 
2D SESSION 
H. R. 7475 
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 HOUSE OF REPRESENTATIVES 
APRIL 7, 2022 
Ms. MOORE of Wisconsin (for herself, Ms. UNDERWOOD, Ms. ADAMS, Mrs. 
DINGELL, and Ms. PRESSLEY) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
coverage under the Medicaid program for services pro-
vided by doulas and midwives, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Mamas First Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) According to the Centers for Disease Con-
trol and Prevention, the maternal mortality rate var-
ies drastically for women by race and ethnicity. On 
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average, there are 12.7 deaths per 100,000 live 
births for White women, 43.5 deaths per 100,000 
live births for African-American women, 32.5 deaths 
for American Indian and Alaskan Native women, 
and 14.4 deaths per 100,000 live births for women 
of other ethnicities. While maternal mortality dispar-
ately impacts African-American women and indige-
nous women, this urgent public health crisis tra-
verses race, ethnicity, socioeconomic status, edu-
cational background, and geography. 
(2) United States maternal mortality rates are 
the highest in the developed world and are increas-
ing rapidly. 
(3) Many of these maternal deaths are likely 
preventable. 
(4) According to the National Institutes of 
Health, doula-assisted mothers are four times less 
likely to have a low-birth-weight baby, two times less 
likely to experience a birth complication involving 
themselves or their baby, and significantly more like-
ly to initiate breastfeeding. 
(5) Midwife-led care is associated with cost sav-
ings, decreased rates of intervention, lower cesarean 
rates, lower preterm birth rates, and healthier out-
comes for mothers and babies. 
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(6) Midwives may practice in any setting, in-
cluding the home, community, hospitals, birth cen-
ters, clinics, or health units. 
SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY 
DOULAS AND MIDWIVES. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (30), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (31) as 
paragraph (32); and 
(C) by inserting after paragraph (30) the 
following new paragraph: 
‘‘(31) services and care, including prenatal, de-
livery, and postpartum care, that is provided in a 
culturally congruent manner (as defined in sub-
section (kk)) by doulas, midwives, and tribal mid-
wives (as those terms are defined in subsection (jj)), 
that is provided in the home, community, a hospital, 
birth center, clinic, health unit, or is furnished via 
telehealth to the extent authorized under State law; 
and’’; and 
(2) by adding at the end the following: 
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‘‘(jj) DOULAS, MIDWIVES, AND TRIBAL MIDWIFE 
DEFINED.—For purposes of subsection (a)(31): 
‘‘(1) DOULAS
DEFINED.—The term ‘doula’ 
means an individual who— 
‘‘(A) 
has 
completed 
hours 
of 
foundational training; 
‘‘(B) is certified by an organization, which 
has been established for not less than five years 
and which requires the completion of continuing 
education to maintain such certification, to pro-
vide non-medical advice, information, emotional 
support, and physical comfort to an individual 
during such individual’s pregnancy, childbirth, 
and postpartum period; and 
‘‘(C) maintains such certification by com-
pleting such required continuing education. 
‘‘(2) MIDWIVES DEFINED.—The term ‘midwife’ 
means a midwife who meets at a minimum the inter-
national definition of the midwife and global stand-
ards for midwifery education as established by the 
International Confederation of Midwives. 
‘‘(3) TRIBAL
MIDWIFE
DEFINED.—The term 
‘tribal midwife’ means an individual who is recog-
nized by an Indian tribe (as defined in section 4 of 
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the Indian Health Care Improvement Act (25 U.S.C. 
1603)) to practice midwifery for such tribe. 
‘‘(kk) CULTURALLY CONGRUENT CARE DEFINED.— 
For purposes of subsection (a)(31), the term ‘culturally 
congruent care’, with respect to maternity care, means 
care that is provided in agreement with the preferred cul-
tural values, beliefs, worldview, language, and practices of 
the health care consumer and other stakeholders.’’. 
(b) REQUIRING
MANDATORY
COVERAGE
UNDER 
STATE PLAN.—Section 1902(a)(10)(A) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 
matter preceding clause (i), by striking ‘‘and (30)’’ and 
inserting ‘‘(30), and (31)’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall apply 
with respect to medical assistance furnished on or 
after January 1, 2022. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.) that the 
Secretary of Health and Human Services determines 
requires State legislation in order for the respective 
plan to meet any requirement imposed by amend-
ments made by this section, the respective plan shall 
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