338 
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— 
(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-
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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 
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 
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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-
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 2021 plan year. 
SEC. 435. COVERAGE OF MATERNITY CARE FOR DEPEND-
ENT 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-
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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.’’. 
SEC. 436. 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: 
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‘‘(i) Any services by an officer or em-
ployee under this chapter relating to en-
rolling individuals in a health benefits plan 
under this chapter, or changing the enroll-
ment of an individual already so enrolled 
due to an event described in section 
5(a)(1) of the Healthy MOM Act, shall be 
deemed, for purposes of section 1342 of 
title 31, services 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. 437. CONTINUATION OF MEDICAID INCOME ELIGI-
BILITY STANDARD FOR PREGNANT INDIVID-
UALS 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; 
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(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 
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, 2020, 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 indi-
viduals under the State’s authorizing 
legislation or provided for under the 
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targeted investments to address inequities in health 
and health care to make sure that health care deliv-
ery and payment efforts are responsive to and inclu-
sive of the needs of communities of color and other 
communities experiencing disparities; and 
(6) new models of value-based payment and 
care delivery should consider the holistic needs of 
the patient population and behavioral health, oral 
health, their history of adverse childhood experiences 
and adverse community environments, social deter-
minants of health, social risk factors, unmet social 
needs, and the burden of intergenerational racial 
and other inequities. 
SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES 
REPORTING AND VALUE-BASED PROGRAMS. 
(a) ADVANCING HEALTH EQUITY IN REPORTING AND 
VALUE-BASED PAYMENT PROGRAMS.— 
(1) IN GENERAL.—The Administrator shall re-
quire that a clinician or other professional partici-
pating in any pay-for-reporting or value-based pay-
ment program stratify clinical quality measures by 
disparity variables, including race, ethnicity, sex, pri-
mary language, disability status, sexual orientation, 
gender identity, and socioeconomic status. A clini-
cian or other professional may use existing demo-
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graphic data collection fields in certified electronic 
health record technology (as defined in section 
1848(o)(4) of the Social Security Act (42 U.S.C. 
1395w–4(o)(4)) to carry out such data stratification 
under the preceding sentence. Such stratified data 
will assist clinicians and other professionals in the 
identification of disparities obscured in aggregated 
data and assist with the provision of interventions 
that target reducing those disparities. 
(2) CLINICIAN.—In assessing performance in 
any value-based payment program, the Adminis-
trator shall incorporate a clinician or other profes-
sional’s performance in reducing disparities across 
race, ethnicity, sex, primary language, disability sta-
tus, sexual orientation, gender identity, and socio-
economic status. Linking performance payments to 
the reduction of health care disparities across such 
variables will assist in holding clinicians and other 
professionals accountable for providing quality care 
that can lead to decreased health inequities. 
(3) REQUIREMENT OF ADOPTION OF CERT.—All 
entities, clinicians, or other professionals partici-
pating in the Quality Payment Program shall be re-
quired to adopt 2015 certified electronic health 
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record technology (as so defined) as a condition of 
participating in the Quality Payment Program. 
(b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad-
ministrator, upon yearly review of the Quality Payment 
Program, shall add quality improvement activities that im-
plement the Culturally and Linguistically Accessible 
Standards (CLAS) standards as Improvement Activities 
under the Quality Payment Program. 
SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY RE-
DUCING DELIVERY AND PAYMENT MODELS. 
(a) IN GENERAL.—The Center for Medicare and 
Medicaid Innovation established under section 1115A of 
the Social Security Act (42 U.S.C. 1315a) (in this section 
referred to as the ‘‘CMI’’) shall establish a dedicated fund 
to identify, test, evaluate, and scale delivery and payment 
models under the applicable titles (as defined in subsection 
(a)(4)(B) of such section) that target health disparities 
among racial and ethnic minorities, including models that 
support high-value non-medical services that address so-
cially determined barriers to health, including English pro-
ficiency status, low health literacy, case management, 
transportation, enrollment assistance needs, stable and af-
fordable housing, utility assistance, employment and ca-
reer development, and nutrition and food security which 
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will help to reduce disparities and impact the overall cost 
of care. 
(b) AMENDMENT TO SOCIAL SECURITY ACT.—Sec-
tion 1115A(a)(1) of the Social Security Act (42 U.S.C. 
1315a(a)(1)) is amended as follows: 
‘‘(1) The purpose of the CMI is to test innova-
tive payment and service delivery models to reduce 
program expenditures and improve health equity 
under the applicable titles while preserving or en-
hancing the quality of care furnished to individuals 
under such titles.’’. 
(c) PILOT PROGRAMS.—The CMI shall prioritize the 
testing of models under such section 1115A that include 
partnerships with entities, including community-based or-
ganizations or other nonprofit entities, to help address so-
cially determined barriers to health and health care. 
(d) ALTERNATIVES.—Any model tested by the CMI 
under such 1115A shall include measures to assess and 
track the impact of the model on health disparities, using 
existing measures such as the Healthcare Disparities and 
Cultural Competency Measures endorsed by the entity 
with a contract under section 1890(a) of the Social Secu-
rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 
ethnicity, English proficiency, gender identity, sexual ori-
entation, and disability status. 
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SEC. 444. DIVERSITY IN CENTERS FOR MEDICARE & MED-
ICAID CONSULTATION. 
(a) IN GENERAL.—In carrying out the duties under 
this section, the CMI shall consult representatives of rel-
evant Federal agencies, and clinical and analytical experts 
with expertise in medicine and health care management, 
specifically such experts with expertise in— 
(1) the health care needs of minority, rural, and 
underserved populations; and 
(2) the financial needs of safety net, commu-
nity-based, rural, and critical access providers, in-
cluding federally qualified health centers. 
(b) OPEN DOOR FORUMS.—The CMI shall use open 
door forums or other mechanisms to seek external feed-
back from interested parties and incorporate that feedback 
into the development of models. 
SEC. 445. SUPPORTING SAFETY NET AND COMMUNITY- 
BASED PROVIDERS TO COMPETE IN VALUE- 
BASED PAYMENT SYSTEMS. 
(a) IN GENERAL.—Any pay-for-performance or alter-
native payment model that is developed and tested by the 
Center for Medicare and Medicaid Innovation established 
under section 1115A of the Social Security Act (42 U.S.C. 
1315a), or any other agency of the Department of Health 
and Human Services with respect to the programs under 
titles XVIII, XIX, or XXI of such Act, shall be assessed 
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for potential impact on safety net, community-based, and 
critical access providers, including federally qualified 
health centers. 
(b) NEW MODELS.—The rollout of any such models 
shall include training and additional up front resources for 
community-based and safety net providers to enable those 
providers to participate in the model. 
Subtitle D—Health Empowerment 
Zones 
SEC. 451. SHORT TITLE. 
This subtitle may be cited as the ‘‘Health Empower-
ment Zone Act of 2020’’. 
SEC. 452. FINDINGS. 
Congress finds the following: 
(1) Numerous studies and reports, including 
the 2015 National Healthcare Quality and Dispari-
ties Report of the Agency for Healthcare Research 
and Quality and the 2002 report of the Institute of 
Medicine entitled ‘‘Unequal Treatment: Confronting 
Racial and Ethnic Disparities in Health Care’’, doc-
ument the extensiveness to which health disparities 
exist across the country. 
(2) These studies have found that, on average, 
racial and ethnic minorities are disproportionately 
afflicted with chronic and acute conditions—such as 
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cancer, diabetes, musculoskeletal disease, obesity, 
and hypertension—and suffer worse health out-
comes, worse health status, and higher mortality 
rates than their White counterparts. 
(3) Several recent studies also show that health 
disparities are a function of not only access to health 
care, but also the social determinants of health—in-
cluding the environment, the physical structure of 
communities, nutrition and food options, educational 
attainment and health literacy, employment, race, 
ethnicity, immigration status, geography, and lan-
guage preference—that directly and indirectly affect 
the health, health care, and wellness of individuals 
and communities. 
(4) Integrally involving and fully supporting the 
communities most affected by health inequities in 
the assessment, planning, launch, and evaluation of 
health disparity elimination efforts are among the 
leading recommendations made to adequately ad-
dress and ultimately reduce health disparities. 
(5) Recommendations also include supporting 
the efforts of community stakeholders from a broad 
cross section—including local businesses, local de-
partments of commerce, education, labor, urban 
planning, and transportation, and community-based 
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and other nonprofit organizations, including national 
and regional intermediaries with demonstrated ca-
pacity to serve low-income urban communities—to 
find areas of common ground around health dis-
parity elimination and collaborate to improve the 
overall health and wellness of a community and its 
residents. 
SEC. 
453. 
DESIGNATION 
OF 
HEALTH 
EMPOWERMENT 
ZONES. 
(a) IN GENERAL.—The Secretary may, at the request 
of an eligible community partnership described in sub-
section (b)(1), designate an eligible area described in sub-
section (b)(2) as a health empowerment zone for the pur-
pose of eligibility for a grant under section 455. 
(b) ELIGIBILITY CRITERIA.— 
(1) ELIGIBLE
COMMUNITY
PARTNERSHIP.—A 
community partnership is eligible to submit a re-
quest under this section if the partnership— 
(A) demonstrates widespread public sup-
port from key individuals and entities in the eli-
gible area, including members of the target 
community, State and local governments, non-
profit organizations including national and re-
gional intermediaries with demonstrated capac-
ity to serve low-income urban communities, and 
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community and industry leaders, for designa-
tion of the eligible area as a health empower-
ment zone; and 
(B) includes representatives of— 
(i) a broad cross section of stake-
holders and residents from communities in 
the eligible area experiencing dispropor-
tionate disparities in health status and 
health care; and 
(ii) organizations, facilities, and insti-
tutions that have a history of working 
within and serving such communities. 
(2) ELIGIBLE AREA.—An area is eligible to be 
designated as a health empowerment zone under this 
section if one or more communities in the area expe-
rience disproportionate disparities in health status 
and health care. In determining whether a commu-
nity experiences such disparities, the Secretary shall 
consider data collected by the Department of Health 
and Human Services focusing on the following areas: 
(A) Access to affordable, high-quality 
health services. 
(B) The prevalence of disproportionate 
rates of certain illnesses or diseases including 
the following: 
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(i) Arthritis, osteoporosis, chronic 
back conditions, and other musculoskeletal 
diseases. 
(ii) Cancer. 
(iii) Chronic kidney disease. 
(iv) Diabetes. 
(v) Injury (intentional and uninten-
tional). 
(vi) Violence (intimate and non-
intimate). 
(vii) Maternal and paternal illnesses 
and diseases. 
(viii) Infant mortality. 
(ix) Mental illness and other disabil-
ities. 
(x) Substance use disorder treatment 
and prevention, including underage drink-
ing. 
(xi) Nutrition, obesity, and overweight 
conditions. 
(xii) Heart disease. 
(xiii) Hypertension. 
(xiv) 
Cerebrovascular 
disease 
or 
stroke. 
(xv) Tuberculosis. 
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(xvi) HIV/AIDS and other sexually 
transmitted infections. 
(xvii) Viral hepatitis. 
(xviii) Asthma. 
(xix) Tooth decay and other oral 
health issues. 
(C) Within the community, the historical 
and persistent presence of conditions that have 
been found to contribute to health disparities 
including any such conditions respecting any of 
the following: 
(i) Poverty. 
(ii) Educational status and the quality 
of community schools. 
(iii) Income. 
(iv) Access to high-quality affordable 
health care. 
(v) Work and work environment. 
(vi) Environmental conditions in the 
community, including with respect to clean 
water, clean air, and the presence or ab-
sence of pollutants. 
(vii) Language and English pro-
ficiency. 
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the Secretary shall approve or disapprove the re-
quest. 
(d) MINIMUM NUMBER.—The Secretary— 
(1) shall designate not more than 110 health 
empowerment zones under this section; and 
(2) shall designate at least one health empower-
ment zone in each of the several States, the District 
of Columbia, and each territory or possession of the 
United States. 
SEC. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION. 
At the request of any organization or entity seeking 
to submit a request under section 453(a), the Secretary 
shall provide technical assistance, and may award a grant, 
to assist such organization or entity— 
(1) to form an eligible community partnership 
described in section 453(b)(1); 
(2) to complete a health assessment, including 
an assessment of health disparities under section 
453(c)(1)(D); or 
(3) to prepare and submit a request, including 
a strategic plan, in accordance with section 453. 
SEC. 455. BENEFITS OF DESIGNATION. 
(a) PRIORITY.—In awarding a grant under sub-
section (b), a Federal official shall give priority to any ap-
plicant that— 
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(1) meets the eligibility criteria for the grant; 
(2) proposes to use the grant for activities in a 
health empowerment zone; and 
(3) demonstrates that such activities will di-
rectly and significantly further the goals of the stra-
tegic plan approved for such zone under section 453. 
(b) GRANTS
FOR INITIAL IMPLEMENTATION
OF 
STRATEGIC PLAN.— 
(1) IN GENERAL.—Upon designating an eligible 
area as a health empowerment zone at the request 
of an eligible community partnership, the Secretary 
shall, subject to the availability of appropriations, 
make a grant to the community partnership for im-
plementation of the strategic plan for such zone. 
(2) GRANT PERIOD.—A grant under paragraph 
(1) for a health empowerment zone shall be for a pe-
riod of 2 years and may be renewed, except that the 
total period of grants under paragraph (1) for such 
zone may not exceed 10 years. 
(3) LIMITATION.—In awarding grants under 
this subsection, the Secretary shall not give less pri-
ority to an applicant or reduce the amount of a 
grant because the Secretary rendered technical as-
sistance or made a grant to the same applicant 
under section 454. 
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(4) REPORTING.—The Secretary shall establish 
metrics for measuring the progress of grantees 
under this subsection and, based on such metrics, 
require each such grantee to report to the Secretary 
not less than every 6 months on the progress in im-
plementing the strategic plan for the health em-
powerment zone. 
SEC. 456. DEFINITION OF SECRETARY. 
In this subtitle, the term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services, acting through the 
Administrator of the Health Resources and Services Ad-
ministration and the Deputy Assistant Secretary for Mi-
nority Health, and in cooperation with the Director of the 
Office of Community Services and the Director of the Na-
tional Institute on Minority Health and Health Dispari-
ties. 
SEC. 457. AUTHORIZATION OF APPROPRIATIONS. 
To carry out this subtitle, there is authorized to be 
appropriated $100,000,000 for fiscal year 2021. 
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TITLE V—IMPROVING HEALTH 
OUTCOMES 
FOR 
WOMEN, 
CHILDREN, AND FAMILIES 
Subtitle A—In General 
SEC. 501. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Administrator of the Health Resources 
and Services Administration and other Federal officials 
determined appropriate by the Secretary, is authorized to 
award grants to eligible entities— 
‘‘(1) to promote health for underserved commu-
nities, with preference given to projects that benefit 
racial and ethnic minority women, racial and ethnic 
minority children, adolescents, and lesbian, gay, bi-
sexual, transgender, queer, or questioning commu-
nities; and 
‘‘(2) to strengthen health outreach initiatives in 
medically underserved communities, including lin-
guistically isolated populations. 
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‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support the activities of 
community health workers, including such activities— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate and provide outreach in a com-
munity setting regarding health problems prevalent 
among underserved communities, and especially 
among racial and ethnic minority women, racial and 
ethnic minority children, adolescents, and lesbian, 
gay, bisexual, transgender, queer, or questioning 
communities; 
‘‘(3) to educate and provide experiential learn-
ing opportunities and target risk factors and healthy 
behaviors that impede or contribute to achieving 
positive health outcomes, including— 
‘‘(A) healthy nutrition; 
‘‘(B) physical activity; 
‘‘(C) overweight or obesity; 
‘‘(D) tobacco use, including the use of e- 
cigarettes and vaping; 
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‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) sexual health; 
‘‘(H) mental health; 
‘‘(I) musculoskeletal health and arthritis; 
‘‘(J) prenatal and postnatal care; 
‘‘(K) dental and oral health; 
‘‘(L) understanding informed consent; 
‘‘(M) stigma; and 
‘‘(N) environmental hazards; 
‘‘(4) to promote community wellness and aware-
ness; and 
‘‘(5) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
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‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that, with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides in-language training and 
supervision to community health workers to en-
able such workers to provide authorized pro-
gram activities in (at least) the most commonly 
used languages within a particular geographic 
region; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide culturally com-
petent services in the linguistic context most 
appropriate for the individuals served by the 
program; 
‘‘(E) contain a plan to document and dis-
seminate project descriptions and results to 
other States and organizations as identified by 
the Secretary; and 
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‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services, as the 
Secretary determines to be appropriate, 
which may include transportation and 
translation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas 
that— 
‘‘(A)(i) have a high percentage of residents 
who are uninsured or underinsured (if the tar-
geted geographic area is located in a State that 
has elected to make medical assistance available 
under section 1902(a)(10)(A)(i)(VIII) of the 
Social Security Act to individuals described in 
such section); 
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‘‘(ii) have a high percentage of under-
insured residents in a particular geographic 
area (if the targeted geographic area is located 
in a State that has not so elected); or 
‘‘(iii) have a high number of households ex-
periencing extreme poverty; and 
‘‘(B) have a high percentage of families for 
whom English is not their primary language or 
including smaller limited English proficient 
communities within the region that are not oth-
erwise reached by linguistically appropriate 
health services; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE-
NESS.—The Secretary shall establish guidelines for ensur-
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ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for ensuring the cost effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
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‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of these programs on 
the health outcomes of the community resi-
dents. 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
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‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
‘‘(F) by taking into consideration the 
needs of the communities served, including the 
prevalence rates of risk factors that impede 
achieving positive healthy outcomes among 
women and children, especially among racial 
and ethnic minority women and children; and 
‘‘(G) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation that serves a population. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
Tribal government (including a federally recog-
nized Tribe or Alaska Native village); or 
‘‘(B) a community-based organization. 
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‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
derserved population, as defined by section 
330(b)(3); 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332; and 
‘‘(C) that includes populations that are lin-
guistically isolated, such as geographic areas 
with a shortage of health professionals able to 
provide linguistically appropriate services. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2021 through 2025.’’. 
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SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU-
TRITION ASSISTANCE FOR CHILDREN, PREG-
NANT PERSONS, AND LAWFULLY PRESENT IN-
DIVIDUALS. 
(a) MEDICAID.—Section 1903(v) of the Social Secu-
rity Act (42 U.S.C. 1396b(v)) is amended by striking 
paragraph (4) and inserting the following new paragraph: 
‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 
403, and 421 of the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996 and paragraph (1), 
payment shall be made to a State under this section for 
medical assistance furnished to an alien under this title 
(including an alien described in such paragraph) who 
meets any of the following conditions: 
‘‘(i) The alien is otherwise eligible for such as-
sistance under the State plan approved under this 
title (other than the requirement of the receipt of 
aid or assistance under title IV, supplemental secu-
rity income benefits under title XVI, or a State sup-
plementary payment) within either or both of the 
following eligibility categories: 
‘‘(I) Children under 21 years of age, in-
cluding any optional targeted low-income child 
(as 
such 
term 
is 
defined 
in 
section 
1905(u)(2)(B)). 
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‘‘(II) Pregnant persons during pregnancy 
and during the 12-month period beginning on 
the last day of the pregnancy. 
‘‘(ii) The alien is lawfully present in the United 
States. 
‘‘(B) No debt shall accrue under an affidavit of sup-
port against any sponsor of an alien who meets the condi-
tions specified in subparagraph (A) on the basis of the 
provision of medical assistance to such alien under this 
paragraph and the cost of such assistance shall not be con-
sidered as an unreimbursed cost.’’. 
(b) 
SCHIP.—Subparagraph 
(N) 
of 
section 
2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(N) Paragraph (4) of section 1903(v) (re-
lating to coverage of categories of children, 
pregnant persons, and other lawfully present in-
dividuals).’’. 
(c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not-
withstanding sections 401(a), 402(a), and 403(a) of the 
Personal Responsibility and Work Opportunity Reconcili-
ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 
and section 6(f) of the Food and Nutrition Act of 2008 
(7 U.S.C. 2015(f)), persons who are lawfully present in 
the United States shall be not be ineligible for benefits 
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under the supplemental nutrition assistance program on 
the basis of their immigration status or date of entry into 
the United States. 
(d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 
Section 421(d)(3) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 
1631(d)(3)) is amended by striking ‘‘to the extent that 
a qualified alien is eligible under section 402(a)(2)(J)’’ 
and inserting, ‘‘to the extent that a child is a member of 
a household under the supplemental nutrition assistance 
program’’. 
(e) 
ENSURING
PROPER
SCREENING.—Section 
11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 
U.S.C. 2020(e)(2)(B)) is amended— 
(1) by redesignating clauses (vi) and (vii) as 
clauses (vii) and (viii); and 
(2) by inserting after clause (v) the following: 
‘‘(vi) shall provide a method for imple-
menting section 421 of the Personal Re-
sponsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631) 
that does not require any unnecessary in-
formation from persons who may be ex-
empt from that provision;’’. 
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374 
SEC. 503. REPEAL OF DENIAL OF BENEFITS. 
Section 115 of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 
is amended— 
(1) in subsection (a), by striking ‘‘for—’’ and 
all that follows and inserting ‘‘for assistance under 
any State program funded under part A of title IV 
of the Social Security Act (42 U.S.C. 601 et seq.).’’; 
(2) in subsection (b)— 
(A) by striking ‘‘(1) PROGRAM OF TEM-
PORARY ASSISTANCE FOR NEEDY FAMILIES.—’’; 
and 
(B) by striking paragraph (2); and 
(3) in subsection (e), by striking ‘‘it—’’ and all 
that follows and inserting ‘‘the term in section 
419(5) of the Social Security Act (42 U.S.C. 
619(5)) when referring to assistance provided under 
a State program funded under paragraph A of title 
IV of the Social Security Act (42 U.S.C. 601 et 
seq.).’’. 
SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 
AND AWARENESS. 
(a) IN GENERAL.—The Secretary shall establish and 
implement a birth defects prevention and public awareness 
program, consisting of the activities described in sub-
sections (c) and (d). 
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(b) DEFINITIONS.—In this section: 
(1) MATERNAL.—The term ‘‘maternal’’ refers 
to persons who are pregnant or breastfeeding of all 
gender identities. 
(2) PREGNANCY AND BREASTFEEDING INFOR-
MATION
SERVICES.—The term ‘‘pregnancy and 
breastfeeding information services’’ includes only— 
(A) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during pregnancy 
that may be associated with birth defects or 
other health risks, such as exposures to medica-
tions, chemicals, infections, foodborne patho-
gens, illnesses, nutrition, or lifestyle factors; 
(B) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during breast-
feeding that may be associated with health risks 
to a breast-fed infant, such as exposures to 
medications, chemicals, infections, foodborne 
pathogens, illnesses, nutrition, lifestyle, or cli-
mate and weather-related factors; 
(C) the provision of accurate, evidence- 
based information weighing risks of exposures 
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during breastfeeding against the benefits of 
breastfeeding; and 
(D) the provision of information described 
in subparagraph (A), (B), or (C) through coun-
selors, websites, fact sheets, telephonic or elec-
tronic communication, community outreach ef-
forts, or other appropriate means. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease 
Control and Prevention. 
(c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 
subsection (a), the Secretary shall conduct or support a 
nationwide media campaign to increase awareness among 
health care providers and at-risk populations about preg-
nancy and breastfeeding information services. 
(d) GRANTS FOR PREGNANCY AND BREASTFEEDING 
INFORMATION SERVICES.— 
(1) IN GENERAL.—In carrying out subsection 
(a), the Secretary shall award grants to State or re-
gional agencies or organizations for any of the fol-
lowing: 
(A) INFORMATION SERVICES.—The provi-
sion of, or campaigns to increase awareness 
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about, pregnancy and breastfeeding information 
services. 
(B) SURVEILLANCE AND RESEARCH.—The 
conduct or support of— 
(i) surveillance of or research on— 
(I) maternal exposures and ma-
ternal health conditions that may in-
fluence the risk of birth defects, pre-
maturity, or other adverse pregnancy 
outcomes; and 
(II) maternal exposures that may 
influence health risks to a breastfed 
infant; or 
(ii) networking to facilitate surveil-
lance or research described in this sub-
paragraph. 
(2) PREFERENCE FOR CERTAIN STATES.—The 
Secretary, in making any grant under this sub-
section, shall give preference to States, otherwise 
equally qualified, that have a pregnancy and 
breastfeeding information service in place. 
(3) MATCHING
FUNDS.—The Secretary may 
only award a grant under this subsection to a State 
or regional agency or organization that agrees, with 
respect to the costs to be incurred in carrying out 
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the grant activities, to make available (directly or 
through donations from public or private entities) 
non-Federal funds toward such costs in an amount 
equal to not less than 25 percent of the amount of 
the grant. 
(4) COORDINATION.—The Secretary shall en-
sure that activities funded through a grant under 
this subsection are coordinated, to the maximum ex-
tent practicable, with other birth defects prevention 
and environmental health activities of the Federal 
Government, including with respect to pediatric envi-
ronmental health specialty units and children’s envi-
ronmental health centers. 
(e) EVALUATION.—In furtherance of the program 
under subsection (a), the Secretary shall provide for an 
evaluation of pregnancy and breastfeeding information 
services to identify efficient and effective models of— 
(1) providing information; 
(2) raising awareness and increasing knowledge 
about birth defects prevention measures and tar-
geting education to at-risk groups; 
(3) modifying risk behaviors; or 
(4) other outcome measures as determined ap-
propriate by the Secretary. 
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(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
$5,000,000 for fiscal year 2021, $6,000,000 for fiscal year 
2022, $7,000,000 for fiscal year 2023, $8,000,000 for fis-
cal year 2024, and $9,000,000 for fiscal year 2025. 
SEC. 505. MOMMA’S ACT. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Mothers and Offspring Mortality and Morbidity Aware-
ness Act’’ or the ‘‘MOMMA’s Act’’. 
(b) FINDINGS.—Congress finds the following: 
(1) Every year, across the United States, 
4,000,000 women give birth, about 700 women suf-
fer fatal complications during pregnancy, while giv-
ing birth or during the postpartum period, and 
70,000 women suffer near-fatal, partum-related 
complications. 
(2) The maternal mortality rate is often used as 
a proxy to measure the overall health of a popu-
lation. While the infant mortality rate in the United 
States has reached its lowest point, the risk of death 
for women in the United States during pregnancy, 
childbirth, or the postpartum period is higher than 
such risk in many other developed nations. The esti-
mated maternal mortality rate (per 100,000 live 
births) for the 48 contiguous States and Wash-
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ington, DC, increased from 18.8 percent in 2000 to 
23.8 percent in 2014 to 26.6 percent in 2018. This 
estimated rate is on par with such rate for under-
developed nations such as Iraq and Afghanistan. 
(3) International studies estimate the 2015 ma-
ternal mortality rate in the United States as 26.4 
per 100,000 live births, which is almost twice the 
2015 World Health Organization estimation of 14 
per 100,000 live births. 
(4) It is estimated that more than 60 percent 
of maternal deaths in the United States are prevent-
able. 
(5) According to the Centers for Disease Con-
trol and Prevention, the maternal mortality rate var-
ies drastically for women by race and ethnicity. 
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, and 14.4 deaths per 
100,000 live births for women of other ethnicities. 
While maternal mortality disparately impacts Afri-
can-American women, this urgent public health crisis 
traverses race, ethnicity, socioeconomic status, edu-
cational background, and geography. 
(6) African-American women are 3 to 4 times 
more likely to die from causes related to pregnancy 
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and childbirth compared to non-Hispanic White 
women. 
(7) The findings described in paragraphs (1) 
through (6) are of major concern to researchers, 
academics, members of the business community, and 
providers across the obstetrical continuum rep-
resented by organizations such as March of Dimes; 
the Preeclampsia Foundation; the American College 
of Obstetricians and Gynecologists; the Society for 
Maternal-Fetal Medicine; the Association of Wom-
en’s Health, Obstetric, and Neonatal Nurses; the 
California Maternal Quality Care Collaborative; 
Black Women’s Health Imperative; the National 
Birth Equity Collaborative; Black Mamas Matter Al-
liance; EverThrive Illinois; the National Association 
of Certified Professional Midwives; PCOS Challenge: 
The National Polycystic Ovary Syndrome Associa-
tion; and the American College of Nurse Midwives. 
(8) Hemorrhage, cardiovascular and coronary 
conditions, cardiomyopathy, infection, embolism, 
mental health conditions, preeclampsia and eclamp-
sia, polycystic ovary syndrome, infection and sepsis, 
and anesthesia complications are the predominant 
medical causes of maternal-related deaths and com-
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plications. Most of these conditions are largely pre-
ventable or manageable. 
(9) Oral health is an important part of 
perinatal health. Reducing bacteria in a woman’s 
mouth during pregnancy can significantly reduce her 
risk of developing oral diseases and spreading decay- 
causing bacteria to her baby. Moreover, some evi-
dence suggests that women with periodontal disease 
during pregnancy could be at greater risk for poor 
birth outcomes, such as preeclampsia, pre-term 
birth, and low-birth weight. Furthermore, a woman’s 
oral health during pregnancy is a good predictor of 
her newborn’s oral health, and since mothers can 
unintentionally spread oral bacteria to their babies, 
putting their children at higher risk for tooth decay, 
prevention efforts should happen even before chil-
dren are born, as a matter of pre-pregnancy health 
and prenatal care during pregnancy. 
(10) The United States has not been able to 
submit a formal maternal mortality rate to inter-
national data repositories since 2007. Thus, no offi-
cial maternal mortality rate exists for the United 
States. There can be no maternal mortality rate 
without streamlining maternal mortality-related data 
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from the State level and extrapolating such data to 
the Federal level. 
(11) In the United States, death reporting and 
analysis is a State function rather than a Federal 
process. States report all deaths—including mater-
nal deaths—on a semi-voluntary basis, without 
standardization across States. While the Centers for 
Disease Control and Prevention has the capacity and 
system for collecting death-related data based on 
death certificates, these data are not sufficiently re-
ported by States in an organized and standard for-
mat across States such that the Centers for Disease 
Control and Prevention is able to identify causes of 
maternal death and best practices for the prevention 
of such death. 
(12) Vital statistics systems often underesti-
mate maternal mortality and are insufficient data 
sources from which to derive a full scope of medical 
and social determinant factors contributing to ma-
ternal deaths. While the addition of pregnancy 
checkboxes on death certificates since 2003 have 
likely improved States’ abilities to identify preg-
nancy-related deaths, they are not generally com-
pleted by obstetrical providers or persons trained to 
recognize pregnancy-related mortality. Thus, these 
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vital forms may be missing information or may cap-
ture inconsistent data. Due to varying maternal 
mortality-related analyses, lack of reliability, and 
granularity in data, current maternal mortality 
informatics do not fully encapsulate the myriad med-
ical and socially determinant factors that contribute 
to such high maternal mortality rates within the 
United States compared to other developed nations. 
Lack of standardization of data and data sharing 
across States and between Federal entities, health 
networks, and research institutions keep the Nation 
in the dark about ways to prevent maternal deaths. 
(13) Having reliable and valid State data ag-
gregated at the Federal level is critical to the Na-
tion’s ability to quell surges in maternal death and 
imperative for researchers to identify long-lasting 
interventions. 
(14) Leaders in maternal wellness highly rec-
ommend that maternal deaths be investigated at the 
State level first, and that standardized, streamlined, 
de-identified data regarding maternal deaths be sent 
annually to the Centers for Disease Control and Pre-
vention. Such data standardization and collection 
would be similar in operation and effect to the Na-
tional Program of Cancer Registries of the Centers 
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for Disease Control and Prevention and akin to the 
Confidential Enquiry in Maternal Deaths Pro-
gramme in the United Kingdom. Such a maternal 
mortalities and morbidities registry and surveillance 
system would help providers, academicians, law-
makers, and the public to address questions con-
cerning the types of, causes of, and best practices to 
thwart, pregnancy-related or pregnancy-associated 
mortality and morbidity. 
(15) The United Nations Millennium Develop-
ment Goal 5a aimed to reduce by 75 percent, be-
tween 1990 and 2015, the maternal mortality rate, 
yet this metric has not been achieved. In fact, the 
maternal mortality rate in the United States has 
been estimated to have more than doubled between 
2000 and 2014. Yet, because national data are not 
fully available, the United States does not have an 
official maternal mortality rate. 
(16) Many States have struggled to establish or 
maintain Maternal Mortality Review Committees 
(referred to in this section as ‘‘MMRC’’). On the 
State level, MMRCs have lagged because States have 
not had the resources to mount local reviews. State- 
level reviews are necessary as only the State depart-
ments of health have the authority to request med-
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ical records, autopsy reports, and police reports crit-
ical to the function of the MMRC. 
(17) The United Kingdom regards maternal 
deaths as a health systems failure and a national 
committee of obstetrics experts review each maternal 
death or near-fatal childbirth complication. Such 
committee also establishes the predominant course of 
maternal-related deaths from conditions such as 
preeclampsia. Consequently, the United Kingdom 
has been able to reduce its incidence of preeclampsia 
to less than one in 10,000 women—its lowest rate 
since 1952. 
(18) The United States has no comparable, co-
ordinated Federal process by which to review cases 
of maternal mortality, systems failures, or best prac-
tices. Many States have active MMRCs and leverage 
their work to impact maternal wellness. For exam-
ple, the State of California has worked extensively 
with their State health departments, health and hos-
pital systems, and research collaborative organiza-
tions, including the California Maternal Quality Care 
Collaborative and the Alliance for Innovation on Ma-
ternal Health, to establish MMRCs, wherein such 
State has determined the most prevalent causes of 
maternal mortality and recorded and shared data 
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with providers and researchers, who have developed 
and implemented safety bundles and care protocols 
related to preeclampsia, maternal hemorrhage, and 
the like. In this way, the State of California has 
been able to leverage its maternal mortality review 
board system, generate data, and apply those data 
to effect changes in maternal care-related protocol. 
To date, the State of California has reduced its ma-
ternal mortality rate, which is now comparable to 
the low rates of the United Kingdom. 
(19) Hospitals and health systems across the 
United States lack standardization of emergency ob-
stetrical protocols before, during, and after delivery. 
Consequently, many providers are delayed in recog-
nizing critical signs indicating maternal distress that 
quickly escalate into fatal or near-fatal incidences. 
Moreover, any attempt to address an obstetrical 
emergency that does not consider both clinical and 
public health approaches falls woefully under the 
mark of excellent care delivery. State-based maternal 
quality collaborative organizations, such as the Cali-
fornia Maternal Quality Care Collaborative or enti-
ties participating in the Alliance for Innovation on 
Maternal Health (AIM), have formed obstetrical pro-
tocols, tool kits, and other resources to improve sys-
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tem care and response as they relate to maternal 
complications and warning signs for such conditions 
as 
maternal 
hemorrhage, 
hypertension, 
and 
preeclampsia. 
(20) The Centers for Disease Control and Pre-
vention reports that nearly half of all maternal 
deaths occur in the immediate postpartum period— 
the 42 days following a pregnancy—whereas more 
than one-third of pregnancy-related or pregnancy-as-
sociated deaths occur while a person is still preg-
nant. Yet, for women eligible for the Medicaid pro-
gram on the basis of pregnancy, such Medicaid cov-
erage lapses at the end of the month on which the 
60th postpartum day lands. 
(21) The experience of serious traumatic 
events, such as being exposed to domestic violence, 
substance use disorder, or pervasive racism, can 
over-activate the body’s stress-response system. 
Known as toxic stress, the repetition of high doses 
of cortisol to the brain can harm healthy neuro-
logical development, which can have cascading phys-
ical and mental health consequences, as documented 
in the Adverse Childhood Experiences study of the 
Centers for Disease Control and Prevention. 
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(22) A growing body of evidence-based research 
has shown the correlation between the stress associ-
ated with one’s race—the stress of racism—and 
one’s birthing outcomes. The stress of sex and race 
discrimination and institutional racism has been 
demonstrated to contribute to a higher risk of ma-
ternal mortality, irrespective of one’s gestational 
age, maternal age, socioeconomic status, or indi-
vidual-level health risk factors, including poverty, 
limited access to prenatal care, and poor physical 
and mental health (although these are not nominal 
factors). African-American women remain the most 
at risk for pregnancy-associated or pregnancy-re-
lated 
causes 
of 
death. 
When 
it 
comes 
to 
preeclampsia, for example, which is related to obe-
sity, African-American women of normal weight re-
main the most at risk of dying during the perinatal 
period compared to non-African-American obese 
women. 
(23) The rising maternal mortality rate in the 
United States is driven predominantly by the dis-
proportionately high rates of African-American ma-
ternal mortality. 
(24) African-American women are 3 to 4 times 
more likely to die from pregnancy or maternal-re-
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lated distress than are White women, yielding one of 
the greatest and most disconcerting racial disparities 
in public health. 
(25) Compared to women from other racial and 
ethnic 
demographics, 
African-American 
women 
across the socioeconomic spectrum experience pro-
longed, unrelenting stress related to racial and gen-
der discrimination, contributing to higher rates of 
maternal mortality, giving birth to low-weight ba-
bies, and experiencing pre-term birth. Racism is a 
risk factor for these aforementioned experiences. 
This cumulative stress often extends across the life 
course and is situated in everyday spaces where Afri-
can-American women establish livelihood. Structural 
barriers, lack of access to care, and genetic pre-
dispositions to health vulnerabilities exacerbate Afri-
can-American women’s likelihood to experience poor 
or fatal birthing outcomes, but do not fully account 
for the great disparity. 
(26) African-American women are twice as like-
ly to experience postpartum depression, and dis-
proportionately higher rates of preeclampsia com-
pared to White women. 
(27) Racism is deeply ingrained in United 
States systems, including in health care delivery sys-
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391 
tems between patients and providers, often resulting 
in disparate treatment for pain, irreverence for cul-
tural 
norms 
with 
respect 
to 
health, 
and 
dismissiveness. Research has demonstrated that pa-
tients respond more warmly and adhere to medical 
treatment plans at a higher degree with providers of 
the same race or ethnicity or with providers with 
great ability to exercise empathy. However, the pro-
vider pool is not primed with many people of color, 
nor are providers (whether student-doctors in train-
ing or licensed practitioners) consistently required to 
undergo implicit bias, cultural competency, or empa-
thy training on a consistent, on-going basis. 
(c) IMPROVING FEDERAL EFFORTS WITH RESPECT 
TO PREVENTION OF MATERNAL MORTALITY.— 
(1) TECHNICAL ASSISTANCE FOR STATES WITH 
RESPECT TO REPORTING MATERNAL MORTALITY.— 
Not later than one year after the date of enactment 
of this Act, the Director of the Centers for Disease 
Control and Prevention (referred to in this section 
as the ‘‘Director’’), in consultation with the Admin-
istrator of the Health Resources and Services Ad-
ministration, shall provide technical assistance to 
States that elect to report comprehensive data on 
maternal mortality, including oral, mental, and 
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392 
breastfeeding health information, for the purpose of 
encouraging uniformity in the reporting of such data 
and to encourage the sharing of such data among 
the respective States. 
(2) BEST
PRACTICES
RELATING
TO
PREVEN-
TION OF MATERNAL MORTALITY.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act— 
(i) the Director, in consultation with 
relevant patient and provider groups, shall 
issue best practices to State maternal mor-
tality review committees on how best to 
identify and review maternal mortality 
cases, taking into account any data made 
available by States relating to maternal 
mortality, including data on oral, mental, 
and breastfeeding health, and utilization of 
any emergency services; and 
(ii) the Director, working in collabora-
tion with the Health Resources and Serv-
ices Administration, shall issue best prac-
tices to hospitals, State professional society 
groups, and perinatal quality collaboratives 
on how best to prevent maternal mortality. 
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(B) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this sub-
section, there is authorized to be appropriated 
$5,000,000 for each of fiscal years 2021 
through 2025. 
(3) ALLIANCE FOR INNOVATION ON MATERNAL 
HEALTH GRANT PROGRAM.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (referred 
to in this subsection as the ‘‘Secretary’’), acting 
through the Associate Administrator of the Ma-
ternal and Child Health Bureau of the Health 
Resources and Services Administration, shall 
establish a grant program to be known as the 
Alliance for Innovation on Maternal Health 
Grant Program (referred to in this subsection 
as ‘‘AIM’’) under which the Secretary shall 
award grants to eligible entities for the purpose 
of— 
(i) directing widespread adoption and 
implementation of maternal safety bundles 
through collaborative State-based teams; 
and 
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(ii) collecting and analyzing process, 
structure, and outcome data to drive con-
tinuous improvement in the implementa-
tion of such safety bundles by such State- 
based teams with the ultimate goal of 
eliminating preventable maternal mortality 
and severe maternal morbidity in the 
United States. 
(B) ELIGIBLE ENTITIES.—In order to be 
eligible for a grant under paragraph (1), an en-
tity shall— 
(i) submit to the Secretary an applica-
tion at such time, in such manner, and 
containing such information as the Sec-
retary may require; and 
(ii) demonstrate in such application 
that the entity is an interdisciplinary, 
multi-stakeholder, 
national 
organization 
with a national data-driven maternal safety 
and quality improvement initiative based 
on implementation approaches that have 
been proven to improve maternal safety 
and outcomes in the United States. 
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(C) USE
OF
FUNDS.—An eligible entity 
that receives a grant under paragraph (1) shall 
use such grant funds— 
(i) to develop and implement, through 
a robust, multi-stakeholder process, mater-
nal safety bundles to assist States and 
health care systems in aligning national, 
State, and hospital-level quality improve-
ment efforts to improve maternal health 
outcomes, specifically the reduction of ma-
ternal mortality and severe maternal mor-
bidity; 
(ii) to ensure, in developing and im-
plementing maternal safety bundles under 
subparagraph (A), that such maternal 
safety bundles— 
(I) satisfy the quality improve-
ment needs of a State or health care 
system by factoring in the results and 
findings of relevant data reviews, such 
as reviews conducted by a State ma-
ternal mortality review committee; 
and 
(II) address topics such as— 
(aa) obstetric hemorrhage; 
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(bb) maternal mental health; 
(cc) the maternal venous 
system; 
(dd) 
obstetric 
care 
for 
women with substance use dis-
orders, including opioid use dis-
order; 
(ee) postpartum care basics 
for maternal safety; 
(ff) reduction of peripartum 
racial and ethnic disparities; 
(gg) reduction of primary 
caesarean birth; 
(hh) severe hypertension in 
pregnancy; 
(ii) severe maternal mor-
bidity reviews; 
(jj) support after a severe 
maternal morbidity event; 
(kk) thromboembolism; 
(ll) optimization of support 
for breastfeeding; and 
(mm) maternal oral health; 
and 
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(iii) to provide ongoing technical as-
sistance at the national and State levels to 
support implementation of maternal safety 
bundles under subparagraph (A). 
(D) MATERNAL
SAFETY
BUNDLE
DE-
FINED.—For purposes of this subsection, the 
term ‘‘maternal safety bundle’’ means standard-
ized, evidence-informed processes for maternal 
health care. 
(E) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this sub-
section, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2021 
through 2025. 
(4) FUNDING
FOR
STATE-BASED
PERINATAL 
QUALITY COLLABORATIVES DEVELOPMENT AND SUS-
TAINABILITY.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (referred 
to in this subsection as the ‘‘Secretary’’), acting 
through the Division of Reproductive Health of 
the Centers for Disease Control and Prevention, 
shall establish a grant program to be known as 
the State-Based Perinatal Quality Collaborative 
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398 
grant program under which the Secretary 
awards grants to eligible entities for the pur-
pose of development and sustainability of 
perinatal quality collaboratives in every State, 
the District of Columbia, and eligible terri-
tories, in order to measurably improve perinatal 
care and perinatal health outcomes for preg-
nant and postpartum women and their infants. 
(B) GRANT
AMOUNTS.—Grants awarded 
under this subsection shall be in amounts not to 
exceed $250,000 per year, for the duration of 
the grant period. 
(C) STATE-BASED
PERINATAL
QUALITY 
COLLABORATIVE
DEFINED.—For purposes of 
this subsection, the term ‘‘State-based perinatal 
quality collaborative’’ means a network of mul-
tidisciplinary teams that— 
(i) work to improve measurable out-
comes for maternal and infant health by 
advancing evidence-informed clinical prac-
tices using quality improvement principles; 
(ii) work with hospital-based or out-
patient facility-based clinical teams, ex-
perts, and stakeholders, including patients 
and families, to spread best practices and 
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optimize resources to improve perinatal 
care and outcomes; 
(iii) employ strategies that include the 
use of the collaborative learning model to 
provide opportunities for hospitals and 
clinical teams to collaborate on improve-
ment strategies, rapid-response data to 
provide timely feedback to hospital and 
other clinical teams to track progress, and 
quality improvement science to provide 
support and coaching to hospital and clin-
ical teams; and 
(iv) have the goal of improving popu-
lation-level outcomes in maternal and in-
fant health. 
(D) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this sub-
section, there is authorized to be appropriated 
$14,000,000 per year for each of fiscal years 
2021 through 2025. 
(5) EXPANSION OF MEDICAID AND CHIP COV-
ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 
(A) 
REQUIRING
COVERAGE
OF
ORAL 
HEALTH
SERVICES
FOR
PREGNANT
AND 
POSTPARTUM WOMEN.— 
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400 
(i) MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is 
amended— 
(I) in subsection (a)(4)— 
(aa) by striking ‘‘; and (D)’’ 
and inserting ‘‘; (D)’’; and 
(bb) by inserting ‘‘; and (E) 
oral health services for pregnant 
and postpartum women (as de-
fined in subsection (ee))’’ after 
‘‘subsection (bb))’’; and 
(II) by adding at the end the fol-
lowing new subsection: 
‘‘(ee) ORAL HEALTH SERVICES FOR PREGNANT AND 
POSTPARTUM WOMEN.— 
‘‘(1) IN GENERAL.—For purposes of this title, 
the term ‘oral health services for pregnant and 
postpartum women’ means dental services necessary 
to prevent disease and promote oral health, restore 
oral structures to health and function, and treat 
emergency conditions that are furnished to a woman 
during pregnancy (or during the 1-year period be-
ginning on the last day of the pregnancy). 
‘‘(2) COVERAGE
REQUIREMENTS.—To satisfy 
the requirement to provide oral health services for 
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401 
pregnant and postpartum women, a State shall, at 
a minimum, provide coverage for preventive, diag-
nostic, periodontal, and restorative care consistent 
with recommendations for perinatal oral health care 
and dental care during pregnancy from the Amer-
ican Academy of Pediatric Dentistry and the Amer-
ican College of Obstetricians and Gynecologists.’’. 
(ii) CHIP.—Section 2103(c)(5)(A) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(c)(5)(A)) is amended by inserting 
‘‘or 
a 
targeted 
low-income 
pregnant 
woman’’ after ‘‘targeted low-income child’’. 
(B) EXTENDING MEDICAID COVERAGE FOR 
PREGNANT AND POSTPARTUM WOMEN.—Section 
1902 of the Social Security Act (42 U.S.C. 
1396a) is amended— 
(i) in subsection (e)— 
(I) in paragraph (5)— 
(aa) by inserting ‘‘(including 
oral health services for pregnant 
and postpartum women (as de-
fined in section 1905(ee))’’ after 
‘‘postpartum medical assistance 
under the plan’’; and 
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402 
(bb) by striking ‘‘60-day’’ 
and inserting ‘‘1-year’’; and 
(II) in paragraph (6), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’; and 
(ii) in subsection (l)(1)(A), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’. 
(C) EXTENDING MEDICAID COVERAGE FOR 
LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(v)(4)(A)) is amended by striking ‘‘60- 
day’’ and inserting ‘‘1-year’’. 
(D) EXTENDING
CHIP
COVERAGE
FOR 
PREGNANT AND POSTPARTUM WOMEN.—Section 
2112(d)(2)(A) of the Social Security Act (42 
U.S.C. 1397ll(d)(2)(A)) is amended by striking 
‘‘60-day’’ and inserting ‘‘1-year’’. 
(E) MAINTENANCE OF EFFORT.— 
(i) MEDICAID.—Section 1902(l) of the 
Social Security Act (42 U.S.C. 1396a(l)) is 
amended by adding at the end the fol-
lowing new paragraph: 
‘‘(5) During the period that begins on the date of 
enactment of this paragraph and ends on the date that 
is five years after such date of enactment, as a condition 
for receiving any Federal payments under section 1903(a) 
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403 
for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to women who 
are eligible for medical assistance under the State plan 
or under a waiver of such plan on the basis of being preg-
nant or having been pregnant, eligibility standards, meth-
odologies, or procedures under the State plan or waiver 
that are more restrictive than the eligibility standards, 
methodologies, or procedures, respectively, under such 
plan or waiver that are in effect on the date of enactment 
of this paragraph.’’. 
(ii) CHIP.—Section 2105(d) of the 
Social Security Act (42 U.S.C. 1397ee(d)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) IN
ELIGIBILITY
STANDARDS
FOR
TAR-
GETED
LOW-INCOME
PREGNANT
WOMEN.—During 
the period that begins on the date of enactment of 
this paragraph and ends on the date that is five 
years after such date of enactment, as a condition 
of receiving payments under subsection (a) and sec-
tion 1903(a), a State that elects to provide assist-
ance to women on the basis of being pregnant (in-
cluding pregnancy-related assistance provided to tar-
geted low-income pregnant women (as defined in 
section 2112(d)), pregnancy-related assistance pro-
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404 
vided to women who are eligible for such assistance 
through application of section 1902(v)(4)(A)(i) 
under section 2107(e)(1), or any other assistance 
under the State child health plan (or a waiver of 
such plan) which is provided to women on the basis 
of being pregnant) shall not have in effect, with re-
spect to such women, eligibility standards, meth-
odologies, or procedures under such plan (or waiver) 
that are more restrictive than the eligibility stand-
ards, methodologies, or procedures, respectively, 
under such plan (or waiver) that are in effect on the 
date of enactment of this paragraph.’’. 
(F) INFORMATION
ON
BENEFITS.—The 
Secretary of Health and Human Services shall 
make publicly available on the internet website 
of the Department of Health and Human Serv-
ices, information regarding benefits available to 
pregnant and postpartum women and under the 
Medicaid program and the Children’s Health 
Insurance Program, including information on— 
(i) benefits that States are required to 
provide 
to 
pregnant 
and 
postpartum 
women under such programs; 
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(ii) optional benefits that States may 
provide 
to 
pregnant 
and 
postpartum 
women under such programs; and 
(iii) the availability of different kinds 
of benefits for pregnant and postpartum 
women, including oral health and mental 
health benefits, under such programs. 
(G) FEDERAL FUNDING FOR COST OF EX-
TENDED MEDICAID AND CHIP COVERAGE FOR 
POSTPARTUM WOMEN.— 
(i) MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d), as 
amended by paragraph (1), is further 
amended— 
(I) in subsection (b), by striking 
‘‘and (aa)’’ and inserting ‘‘(aa), and 
(ff)’’; and 
(II) by adding at the end the fol-
lowing: 
‘‘(ff) INCREASED FMAP FOR EXTENDED MEDICAL 
ASSISTANCE
FOR
POSTPARTUM
WOMEN.—Notwith-
standing subsection (b), the Federal medical assistance 
percentage for a State, with respect to amounts expended 
by such State for medical assistance for a woman who is 
eligible for such assistance on the basis of being pregnant 
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406 
or having been pregnant that is provided during the 305- 
day period that begins on the 60th day after the last day 
of her pregnancy (including any such assistance provided 
during the month in which such period ends), shall be 
equal to— 
‘‘(1) 100 percent for the first 20 calendar quar-
ters during which this subsection is in effect; and 
‘‘(2) 90 percent for calendar quarters there-
after.’’. 
(ii) CHIP.—Section 2105(c) of the 
Social Security Act (42 U.S.C. 1397ee(c)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(12) ENHANCED
PAYMENT
FOR
EXTENDED 
ASSISTANCE
PROVIDED
TO
PREGNANT
WOMEN.— 
Notwithstanding 
subsection 
(b), 
the 
enhanced 
FMAP, with respect to payments under subsection 
(a) for expenditures under the State child health 
plan (or a waiver of such plan) for assistance pro-
vided under the plan (or waiver) to a woman who is 
eligible for such assistance on the basis of being 
pregnant (including pregnancy-related assistance 
provided to a targeted low-income pregnant woman 
(as defined in section 2112(d)), pregnancy-related 
assistance provided to a woman who is eligible for 
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such assistance through application of section 
1902(v)(4)(A)(i) under section 2107(e)(1), or any 
other assistance under the plan (or waiver) provided 
to a woman who is eligible for such assistance on the 
basis of being pregnant) during the 305-day period 
that begins on the 60th day after the last day of her 
pregnancy (including any such assistance provided 
during the month in which such period ends), shall 
be equal to— 
‘‘(A) 100 percent for the first 20 calendar 
quarters during which this paragraph is in ef-
fect; and 
‘‘(B) 90 percent for calendar quarters 
thereafter.’’. 
(H) EFFECTIVE DATE.— 
(i) IN GENERAL.—Subject to subpara-
graph (B), the amendments made by this 
subsection shall take effect on the first day 
of the first calendar quarter that begins on 
or after the date that is one year after the 
date of enactment of this Act. 
(ii) EXCEPTION FOR STATE LEGISLA-
TION.—In the case of a State plan under 
title XIX of the Social Security Act or a 
State child health plan under title XXI of 
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(V) land use; 
(VI) solid waste; 
(VII) housing; 
(VIII) violence; 
(IX) socioeconomic status; 
(X) ethnicity, social construct 
and language preference; 
(XI) educational attainment; 
(XII) employment; 
(XIII) food safety, accessibility, 
and affordability; 
(XIV) nutrition; 
(XV) health care services; and 
(XVI) injuries; 
(ii) building partnerships between 
planning, public health, and other sectors, 
including child-serving institutions, to ad-
dress how the built environment impacts 
food availability and access and physical 
activity to promote healthy behaviors and 
lifestyles and reduce overweight and obe-
sity, musculoskeletal diseases, respiratory 
conditions, dental, oral and mental health 
conditions, 
poverty, 
and 
related 
co- 
morbidities; 
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