I 
116TH CONGRESS 
1ST SESSION H. R. 2778 
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 15, 2019 
Mrs. WATSON COLEMAN (for herself, Ms. ADAMS, Ms. BARRAGA´N, Ms. 
BONAMICI, Ms. CLARK of Massachusetts, Ms. CLARKE of New York, Mr. 
COHEN, Mr. CONNOLLY, Ms. DELBENE, Mrs. DINGELL, Mr. MICHAEL 
F. DOYLE of Pennsylvania, Mr. ENGEL, Mr. ESPAILLAT, Mr. FOSTER, 
Ms. FRANKEL, Mr. GALLEGO, Mr. GRIJALVA, Ms. HAALAND, Mr. HAS-
TINGS, Ms. JACKSON LEE, Ms. KELLY of Illinois, Mr. KHANNA, Mrs. 
KIRKPATRICK, Mr. LANGEVIN, Mrs. LAWRENCE, Ms. LEE of California, 
Mr. LEWIS, Ms. MCCOLLUM, Ms. MENG, Mr. SEAN PATRICK MALONEY 
of New York, Ms. MOORE, Mr. MOULTON, Mr. NADLER, Ms. NORTON, 
Mr. PASCRELL, Mr. RASKIN, Ms. ROYBAL-ALLARD, Mr. RYAN, Mr. 
SCHIFF, Mr. TONKO, Mr. TRONE, Ms. WILSON
of Florida, Ms. 
WASSERMAN SCHULTZ, Ms. VELA´ZQUEZ, Mrs. BEATTY, Mr. VEASEY, Mr. 
VARGAS, Mr. BROWN of Maryland, Ms. BASS, Mr. THOMPSON of Mis-
sissippi, and Mr. RICHMOND) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committees on Ways and Means, Oversight and Reform, and Edu-
cation and Labor, 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. 
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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 ‘‘Healthy Maternity and 
Obstetric Medicine Act’’ or the ‘‘Healthy MOM Act’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress finds the following: 
(1) Pregnancy is a significant life event for mil-
lions of women in the United States each year. 
(2) For more than 30 years, our Nation, 
through the Medicaid program, has recognized that 
pregnant women need immediate access to afford-
able care, and has allowed women who meet income- 
eligibility requirements to enroll in Medicaid cov-
erage when they become pregnant. 
(3) Congress recognized the central importance 
of maternity coverage by classifying maternity and 
newborn care as one of the ten essential health bene-
fits that must now be covered on most individual 
and small group health insurance plans under sec-
tion 1302(b)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18022(b)(1)). 
(4) Congress has also recognized the significant 
challenge of maternal mortality and the need to 
eliminate disparities in maternal health outcomes for 
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pregnancy-related and pregnancy-associated deaths, 
and to improve health outcomes for both mothers 
and babies through passage of the Preventing Ma-
ternal Deaths Act of 2018 (Public Law 115–344). 
(5) Access to comprehensive maternity coverage 
allows women to access important pregnancy-related 
care, which is demonstrated to improve health out-
comes for women and newborns and reduce financial 
costs for both consumers and insurers. 
(6) Uninsured women, women with grand-
fathered and transitional health plans, self-funded 
student health plans, and catastrophic and high-de-
ductible health plans may lack access to comprehen-
sive and affordable maternity coverage. 
(7) Employer health plans that exclude depend-
ent daughters from maternity coverage leave young 
women without coverage for their pregnancy, even 
though Federal law has long held that treating preg-
nancy differently than other conditions is sex-based 
discrimination. 
(8) A special enrollment period is especially im-
portant for young adults, who are at high risk for 
unintended pregnancies, yet young adults are fre-
quently enrolled in catastrophic coverage, which 
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often has fewer benefits, more restrictions, and high-
er deductibles. 
(9) This coverage would be an equalizer for 
communities of color. The maternal mortality rate 
varies drastically by race and ethnicity, and where a 
woman lives. The rising maternal mortality rate in 
the United States is driven predominantly by the 
disproportionately high African-American maternal 
mortality rate, which is four times more than the 
rate for White women. 
(10) According to the Centers for Disease Con-
trol and Prevention, about 700 women die each year 
in the United States from pregnancy-related com-
plications. Black and American Indian/Alaska Native 
women are about three times more likely to die from 
a pregnancy-related cause than White women. 
(11) Data demonstrates that 3 in 5 pregnancy 
related deaths could be prevented. Improving access 
to care is one way to help prevent deaths, regardless 
of race or ethnicity. 
(12) Timely maternity care improves the health 
of pregnant women, as well as birth outcomes and 
the health of babies throughout their lifetimes. Preg-
nancy-related maternal mortality is three to four 
times higher among women who receive no maternity 
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care compared to women who do. Regular maternity 
care can detect or mitigate serious pregnancy-related 
health complications, including preeclampsia, pla-
cental abruption, complications from diabetes, com-
plications from heart disease, and Graves’ disease, 
all of which can result in morbidity or mortality for 
the mother or newborn. 
(13) The Centers for Disease Control and Pre-
vention reports that more than half of all maternal 
deaths occur at delivery or in the first postpartum 
year, whereas just more than one-third of preg-
nancy-related or pregnancy-associated deaths occur 
while a person is still pregnant. Yet, for women eligi-
ble for the Medicaid program on the basis of preg-
nancy, such Medicaid coverage lapses at the end of 
the month on which the 60th postpartum day lands. 
(14) Timely maternity care and adequate 
postpartum care can reduce short- and long-term 
health care costs. If a woman does not have access 
to affordable maternity care during her pregnancy, 
and she or her newborn experiences pregnancy com-
plications that result in health problems after birth, 
their insurer may end up paying much higher costs 
than if the insurer had covered the woman’s mater-
nity care during her pregnancy. Intensive maternity 
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care can reduce hospital and neonatal intensive care 
unit admissions among infants, resulting in cost sav-
ings of $1,768 to $5,560 per birth. For women with 
high-risk pregnancies, intensive maternity care saves 
$1.37 for every $1 invested in maternity care. 
(b) PURPOSE.—The purpose of this Act is to protect 
the health of women and newborns by ensuring that all 
women eligible for coverage through the Exchanges estab-
lished under title I of the Patient Protection and Afford-
able Care Act (Public Law 111–148) and women eligible 
for other individual or group health plan coverage can ac-
cess affordable health coverage during their pregnancy. 
SEC. 3. 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)) is amended by inserting ‘‘including a spe-
cial enrollment period for pregnant individuals, beginning 
on the date on which the pregnancy is reported to the 
health insurance issuer’’ before the period at the end. 
(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)) is amend-
ed— 
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(1) in subparagraph (C), by striking ‘‘and’’ at 
the end; 
(2) by redesignating subparagraph (D) as sub-
paragraph (E); and 
(3) by inserting after subparagraph (C) the fol-
lowing new subparagraph: 
‘‘(D) a special enrollment period for preg-
nant individuals, beginning on the date on 
which the pregnancy is reported to the Ex-
change; and’’. 
(c) SPECIAL ENROLLMENT PERIODS.— 
(1) 
INTERNAL
REVENUE
CODE.—Section 
9801(f) of the Internal Revenue Code of 1986 (26 
U.S.C. 9801(f)) is amended by adding at the end 
the following new paragraph: 
‘‘(4) FOR PREGNANT INDIVIDUALS.— 
‘‘(A) A group health plan shall permit an 
employee who is eligible, but not enrolled, for 
coverage under the terms of the plan (or a de-
pendent 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 spe-
cial enrollment period beginning on the date on 
which the pregnancy is reported to the group 
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health plan or the pregnancy is confirmed by a 
health care provider. 
‘‘(B) The Secretary shall promulgate regu-
lations with respect to the special enrollment 
period under subparagraph (A), including es-
tablishing a time period for pregnant individ-
uals 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)) is amended by adding at the end the fol-
lowing: 
‘‘(4) FOR PREGNANT INDIVIDUALS.— 
‘‘(A) A group health plan or health insur-
ance 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 cov-
erage under the terms of the plan upon preg-
nancy, with the special enrollment period begin-
ning on the date on which the pregnancy is re-
ported to the group health plan or health insur-
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ance issuer or the pregnancy is confirmed by a 
health care provider. 
‘‘(B) The Secretary shall promulgate regu-
lations with respect to the special enrollment 
period under subparagraph (A), including es-
tablishing a time period for pregnant individ-
uals 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 begin-
ning after the 2019 plan year. 
SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 
CHILDREN. 
Section 2719A of the Public Health Service Act (42 
U.S.C. 300gg–19a) is amended by adding at the end the 
following: 
‘‘(e) COVERAGE
OF MATERNITY CARE.—A group 
health plan, or health insurance issuer offering group or 
individual health insurance coverage, that provides cov-
erage for dependants shall ensure that such plan or cov-
erage includes coverage for maternity care associated with 
pregnancy, childbirth, and postpartum care for all partici-
pants, beneficiaries, or enrollees, including dependants, in-
cluding coverage of labor and delivery. Such coverage shall 
be provided to all pregnant dependents regardless of age.’’. 
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SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 
(a) COVERAGE OF PREGNANCY.— 
(1) IN GENERAL.—The Director of the Office of 
Personnel Management shall issue such regulations 
as are necessary to ensure that pregnancy is consid-
ered 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 chap-
ter 89 title 5, United States Code. 
(2) EFFECTIVE
DATE.—The requirement in 
paragraph (1) shall apply with respect to any con-
tract entered into under section 8902 of such title 
beginning 12 months after the date of enactment of 
this Act. 
(b) 
DESIGNATING
CERTAIN
FEHBP-RELATED 
SERVICES AS EXCEPTED SERVICES UNDER THE ANTI- 
DEFICIENCY ACT.— 
(1) IN
GENERAL.—Section 8905 of title 5, 
United States Code, is amended by adding at the 
end the following: 
‘‘(i) Any services by an officer or employee under this 
chapter relating to enrolling individuals in a health bene-
fits plan under this chapter, or changing the enrollment 
of an individual already so enrolled due to an event de-
scribed in section 5(a)(1) of the Healthy MOM Act, shall 
be deemed, for purposes of section 1342 of title 31, serv-
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ices for emergencies involving the safety of human life or 
the protection of property.’’. 
(2) APPLICATION.—The amendment made by 
paragraph (1) shall apply to any lapse in appropria-
tions beginning on or after the date of enactment of 
this Act. 
SEC. 6. 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)) is amended— 
(1) in clause (i), by striking ‘‘and not more 
than 185 percent’’; 
(2) in clause (ii)— 
(A) in subclause (I), by striking ‘‘and’’ 
after the comma; 
(B) in subclause (II), by striking the pe-
riod at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following: 
‘‘(III) January 1, 2020, is the percentage pro-
vided 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, 2020, 
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with respect to individuals described in subparagraph (A) 
or (B) of paragraph (1) shall not be less than— 
‘‘(I) the percentage specified for such individ-
uals 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 legis-
lation or provided for under the State’s appropria-
tions as of that date.’’. 
SEC. 7. 12-MONTH CONTINUOUS COVERAGE FOR PREG-
NANT 
AND 
POSTPARTUM 
INDIVIDUALS 
UNDER MEDICAID AND CHIP. 
(a) MEDICAID.— 
(1) REQUIRED
FOR
ALL
ELIGIBILITY
PATH-
WAYS.—Paragraph (5) of section 1902(e) of the So-
cial Security Act (42 U.S.C. 1396a(e)) is amended 
to read as follows: 
‘‘(5) Any individual who is eligible for medical assist-
ance under the State plan or a waiver of such plan and 
who is, or who while so eligible becomes, pregnant shall 
continue to be eligible under the plan or waiver for medical 
assistance that provides at least essential health benefits 
as described in section 1302(b) of the Patient Protection 
and Affordable Care Act, through the end of the month 
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in which the 1-year period (beginning on the last day of 
her pregnancy) ends, regardless of the basis for the indi-
vidual’s eligibility for medical assistance, including if the 
individual’s eligibility for medical assistance is on the basis 
of being pregnant.’’. 
(2) CONFORMING AMENDMENTS.—Title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended— 
(A) in section 1902— 
(i) in subsection (a)(10), in the mat-
ter following subparagraph (G) by striking 
‘‘(VII) the medical assistance’’ and all that 
follows through ‘‘complicate pregnancy,’’; 
(ii) in subsection (e)(6), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’; and 
(iii) in subsection (l)(1)(A), by strik-
ing ‘‘60-day’’ and inserting ‘‘1-year’’; 
(B) in section 1903(v)(4)(A)(i), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’; and 
(C) in section 1905(a), in the 4th sentence 
in the matter following paragraph (30), by 
striking ‘‘60-day’’ and inserting ‘‘1-year’’. 
(b) CHIP.— 
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(1) IN
GENERAL.—Section 2107(e)(1) of the 
Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(A) by redesignating subparagraphs (H) 
through (S) as subparagraphs (I) through (T), 
respectively; and 
(B) by inserting after subparagraph (G), 
the following: 
‘‘(H) Section 1902(e)(5) (requiring 12- 
month continuous coverage for pregnant indi-
viduals).’’. 
(2) CONFORMING
AMENDMENTS.—Subsections 
(d)(2)(A) and (f)(2) of section 2112 of the Social 
Security Act (42 U.S.C. 1397ll) are each amended 
by striking ‘‘60-day’’ and inserting ‘‘1-year’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall take ef-
fect on the 1st day of the 1st calendar quarter that 
begins on or after the date that is 1 year after the 
date of enactment of this Act. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act or a State child health plan under 
title XXI of such Act that the Secretary of Health 
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and Human Services determines requires State legis-
lation in order for the respective 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 ad-
ditional requirement before the first day of the first 
calendar quarter beginning after the close of the 
first regular session of the State legislature that be-
gins 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. 
SEC. 8. 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 jurisdic-
tion that provides greater or equal protection for enrollees 
in a group health plan or group or individual health insur-
ance offered by a health insurance issuer. 
Æ 
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