I 
116TH CONGRESS 
1ST SESSION H. R. 2602 
To amend titles XIX and XXI of the Social Security Act to improve Medicaid 
and the Children’s Health Insurance Program for low-income mothers. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 8, 2019 
Ms. PRESSLEY (for herself, Ms. ADAMS, and Ms. UNDERWOOD) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend titles XIX and XXI of the Social Security Act 
to improve Medicaid and the Children’s Health Insurance 
Program for low-income mothers. 
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 MOMMIES 
Act’’. 
SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR 
LOW-INCOME PREGNANT WOMEN. 
(a) EXTENDING CONTINUOUS MEDICAID AND CHIP 
COVERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 
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(1) MEDICAID.—Title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.) is amended— 
(A) in section 1902(l)(1)(A), by striking 
‘‘60-day period’’ and inserting ‘‘365-day pe-
riod’’; 
(B) in section 1902(e)(6), by striking ‘‘60- 
day period’’ and inserting ‘‘365-day period’’; 
(C) in section 1903(v)(4)(A)(i), by striking 
‘‘60-day period’’ and inserting ‘‘365-day pe-
riod’’; and 
(D) in section 1905(a), in the 4th sentence 
in the matter following paragraph (30), by 
striking ‘‘60-day period’’ and inserting ‘‘365- 
day period’’. 
(2) CHIP.—Section 2112 of the Social Security 
Act (42 U.S.C. 1397ll) is amended by striking ‘‘60- 
day period’’ each place it appears and inserting 
‘‘365-day period’’. 
(b) REQUIRING FULL BENEFITS
FOR PREGNANT 
AND POSTPARTUM WOMEN.— 
(1) MEDICAID.— 
(A) IN GENERAL.—Paragraph (5) of sec-
tion 1902(e) of the Social Security Act (24 
U.S.C. 1396a(e)) is amended to read as follows: 
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‘‘(H) Section 1902(e)(5) (requiring 365- 
day continuous coverage for pregnant and 
postpartum women).’’. 
(c) REQUIRING COVERAGE OF ORAL HEALTH SERV-
ICES FOR PREGNANT AND POSTPARTUM WOMEN.— 
(1) MEDICAID.—Section 1905 of the Social Se-
curity Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a)(4)— 
(i) by striking ‘‘; and (D)’’ and insert-
ing ‘‘; (D)’’; and 
(ii) by inserting ‘‘; and (E) oral health 
services for pregnant and postpartum 
women (as defined in subsection (ff))’’ 
after ‘‘subsection (bb))’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(ff) 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 
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during pregnancy (or during the 365-day period be-
ginning on the last day of the pregnancy). 
‘‘(2) COVERAGE
REQUIREMENTS.—To satisfy 
the requirement to provide oral health services for 
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.’’. 
(2) CHIP.—Section 2103(c)(5)(A) of the Social 
Security Act (42 U.S.C. 1397cc(c)(5)(A)) is amend-
ed by inserting ‘‘or a targeted low-income pregnant 
woman’’ after ‘‘targeted low-income child’’. 
(d) MAINTENANCE OF EFFORT.— 
(1) MEDICAID.—Section 1902 of the Social Se-
curity Act (42 U.S.C. 1396a) is amended— 
(A) in paragraph (74), by striking ‘‘sub-
section (gg); and’’ and inserting ‘‘subsections 
(gg) and (qq);’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(qq) MAINTENANCE OF EFFORT RELATED TO LOW- 
INCOME PREGNANT WOMEN.—For calendar quarters be-
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ginning on or after the date of enactment of this sub-
section, and before January 1, 2023, no Federal payment 
shall be made to a State under section 1903(a) for 
amounts expended under a State plan under this title or 
a waiver of such plan if the State— 
‘‘(1) has in effect under such plan eligibility 
standards, methodologies, or procedures (including 
any enrollment cap or other numerical limitation on 
enrollment, any waiting list, any procedures designed 
to delay the consideration of applications for enroll-
ment, or similar limitation with respect to enroll-
ment) for individuals described in subsection (l)(1) 
who are eligible for medical assistance under the 
State 
plan 
or 
waiver 
under 
subsection 
(a)(10)(A)(ii)(IX) that are more restrictive than the 
eligibility standards, methodologies, or procedures, 
respectively, for such individuals under such plan or 
waiver that are in effect on the date of the enact-
ment of the Healthy MOMMIES Act; or 
‘‘(2) provides medical assistance to individuals 
described in subsection (l)(1) who are eligible for 
medical assistance under such plan or waiver under 
subsection (a)(10)(A)(ii)(IX) at a level that is less 
than the level at which the State provides such as-
sistance to such individuals under such plan or waiv-
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er on the date of the enactment of the Healthy 
MOMMIES Act.’’. 
(2) CHIP.—Section 2112 of the Social Security 
Act (42 U.S.C. 1397ll), as amended by subsection 
(b), is further amended by adding at the end the fol-
lowing subsection: 
‘‘(g) MAINTENANCE
OF
EFFORT.—For calendar 
quarters beginning on or after January 1, 2020, and be-
fore January 1, 2023, no payment may be made under 
section 2105(a) with respect to a State child health plan 
if the State— 
‘‘(1) has in effect under such plan eligibility 
standards, methodologies, or procedures (including 
any enrollment cap or other numerical limitation on 
enrollment, any waiting list, any procedures designed 
to delay the consideration of applications for enroll-
ment, or similar limitation with respect to enroll-
ment) for targeted low-income pregnant women that 
are more restrictive than the eligibility standards, 
methodologies, or procedures, respectively, under 
such plan that are in effect on the date of the enact-
ment of the Healthy MOMMIES Act; or 
‘‘(2) provides pregnancy-related assistance to 
targeted low-income pregnant women under such 
plan at a level that is less than the level at which 
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the State provides such assistance to such women 
under such plan on the date of the enactment of the 
Healthy MOMMIES Act.’’. 
(e) ENHANCED FMAP.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d), as amended by sub-
section (c), is further amended— 
(1) in subsection (b), by striking ‘‘and (aa)’’ 
and inserting ‘‘(aa), and (gg)’’; and 
(2) by adding at the end the following: 
‘‘(gg) INCREASED FMAP FOR ADDITIONAL EXPEND-
ITURES FOR LOW-INCOME PREGNANT WOMEN.—For cal-
endar quarters beginning on or after January 1, 2020, 
notwithstanding subsection (b), the Federal medical as-
sistance percentage for a State, with respect to the addi-
tional amounts expended by such State for medical assist-
ance under the State plan under this title or a waiver of 
such plan that are attributable to requirements imposed 
by the amendments made by the Healthy MOMMIES Act 
(as determined by the Secretary), shall be equal to 100 
percent.’’. 
(f) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Comp-
troller General of the United States shall submit to 
Congress a report on the gaps in coverage for— 
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(A) pregnant women under the Medicaid 
program under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) and the Children’s 
Health Insurance Program under title XXI of 
the Social Security Act (42 U.S.C. 1397aa et 
seq.); and 
(B) postpartum women under the Medicaid 
program and the Children’s Health Insurance 
Program who received assistance under either 
such program during their pregnancy. 
(2) CONTENT
OF
REPORT.—The report re-
quired under this subsection shall include the fol-
lowing: 
(A) Information about the abilities and 
successes of State Medicaid agencies in deter-
mining whether pregnant and postpartum 
women are eligible under another insurance af-
fordability program, and in transitioning any 
such women who are so eligible to coverage 
under such a program, pursuant to section 
435.1200 of the title 42, Code of Federal Regu-
lations (as in effect on September 1, 2018). 
(B) Information on factors contributing to 
gaps in coverage that disproportionately impact 
underserved populations, including low-income 
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women, women of color, women who reside in a 
health professional shortage area (as defined in 
section 332(a)(1)(A) of the Public Health Serv-
ice Act (42 U.S.C. 254e(a)(1)(A))) or who are 
members of a medically underserved population 
(as defined by section 330(b)(3) of such Act 
(42 U.S.C. 254b(b)(3)(A))). 
(C) Recommendations for addressing and 
reducing such gaps in coverage. 
(D) Such other information as the Comp-
troller General deems necessary. 
(g) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall take effect January 1, 2020. 
SEC. 
3. 
MATERNITY 
CARE 
HOME 
DEMONSTRATION 
PROJECT. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) is amended by inserting the following new section 
after section 1946: 
‘‘MATERNITY CARE HOME DEMONSTRATION PROJECT 
‘‘SEC. 1947. (a) IN GENERAL.—Not later than 1 year 
after the date of the enactment of this section, the Sec-
retary shall establish a demonstration project (in this sec-
tion referred to as the ‘demonstration project’) under 
which the Secretary shall provide grants to States to enter 
into arrangements with eligible entities to implement or 
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expand a maternity care home model for eligible individ-
uals. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means an entity or organization that provides 
medically accurate, comprehensive maternity services 
to individuals who are eligible for medical assistance 
under a State plan under this title or a waiver of 
such a plan, and may include: 
‘‘(A) A freestanding birth center. 
‘‘(B) An entity or organization receiving 
assistance under section 330 of the Public 
Health Service Act. 
‘‘(C) A federally qualified health center. 
‘‘(D) A rural health clinic. 
‘‘(E) A health facility operated by an In-
dian tribe or tribal organization (as those terms 
are defined in section 4 of the Indian Health 
Care Improvement Act). 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means a pregnant woman or a formerly 
pregnant woman during the 365-day period begin-
ning on the last day of her pregnancy who is— 
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‘‘(A) enrolled in a State plan under this 
title, a waiver of such a plan, or a State child 
health plan under title XXI; and 
‘‘(B) a patient of an eligible entity which 
has entered into an arrangement with a State 
under subsection (g). 
‘‘(c) GOALS
OF DEMONSTRATION PROJECT.—The 
goals of the demonstration project are the following: 
‘‘(1) To improve— 
‘‘(A) maternity and infant care outcomes; 
‘‘(B) health equity; 
‘‘(C) communication by maternity, infant 
care, and social services providers; 
‘‘(D) integration of perinatal support serv-
ices, including community health workers, 
doulas, social workers, public health nurses, 
peer lactation counselors, childbirth educators, 
and others, into health care entities and organi-
zations; 
‘‘(E) care coordination between maternity, 
infant care, oral health care, and social services 
providers within the community; 
‘‘(F) the quality and safety of maternity 
and infant care; 
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‘‘(G) the experience of women receiving 
maternity care, including by increasing the abil-
ity of a woman to develop and follow her own 
birthing plan; and 
‘‘(H) access to adequate prenatal and 
postpartum care, including— 
‘‘(i) prenatal care that is initiated in 
a timely manner; 
‘‘(ii) not fewer than 2 post-pregnancy 
visits to a maternity care provider; and 
‘‘(iii) interpregnancy care. 
‘‘(2) To provide coordinated, evidence-based 
maternity care management. 
‘‘(3) To decrease— 
‘‘(A) severe maternal morbidity and mater-
nal mortality; 
‘‘(B) overall health care spending; 
‘‘(C) unnecessary emergency department 
visits; 
‘‘(D) disparities in maternal and infant 
care outcomes, including racial, economic, and 
geographical disparities; 
‘‘(E) racial bias among health care profes-
sionals; 
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‘‘(F) the rate of cesarean deliveries for 
low-risk pregnancies; 
‘‘(G) the rate of preterm births and infants 
born with low birth weight; and 
‘‘(H) the rate of avoidable maternal and 
newborn hospitalizations and admissions to in-
tensive care units. 
‘‘(d) CONSULTATION.—In designing and imple-
menting the demonstration project the Secretary shall 
consult with stakeholders, including— 
‘‘(1) States; 
‘‘(2) organizations representing relevant health 
care professionals, including oral health care profes-
sionals; 
‘‘(3) organizations representing consumers, in-
cluding consumers that are disproportionately im-
pacted by poor maternal health outcomes; 
‘‘(4) representatives with experience imple-
menting other maternity care home models, includ-
ing representatives from the Center for Medicare 
and Medicaid Innovation; 
‘‘(5) community-based health care professionals, 
including doulas, and other stakeholders; and 
‘‘(6) experts in promoting health equity and 
combating racial bias in health care settings. 
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‘‘(e) APPLICATION AND SELECTION OF STATES.— 
‘‘(1) IN GENERAL.—A State seeking to partici-
pate in the demonstration project shall submit an 
application to the Secretary at such time and in 
such manner as the Secretary shall require. 
‘‘(2) SELECTION OF STATES.— 
‘‘(A) IN GENERAL.—The Secretary may se-
lect 15 States to participate in the demonstra-
tion project. 
‘‘(B) SELECTION REQUIREMENTS.—In se-
lecting States to participate in the demonstra-
tion project, the Secretary shall— 
‘‘(i) ensure that there is geographic 
diversity in the areas in which activities 
will be carried out under the project; and 
‘‘(ii) ensure that States with signifi-
cant disparities in maternal and infant 
health outcomes, including severe maternal 
morbidity, and other disparities based on 
race, income, or access to maternity care, 
are included. 
‘‘(f) GRANTS.— 
‘‘(1) IN
GENERAL.—From amounts appro-
priated under subsection (l), the Secretary shall 
award 1 grant for each year of the demonstration 
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project to each State that is selected to participate 
in the demonstration project. 
‘‘(2) USE OF GRANT FUNDS.—A State may use 
funds received under this section to— 
‘‘(A) award grants or make payments to 
eligible entities as part of an arrangement de-
scribed in subsection (g)(2); 
‘‘(B) provide financial incentives to health 
care professionals, including community health 
workers and community-based doulas, who par-
ticipate in the State’s maternity care home 
model; 
‘‘(C) provide adequate training for health 
care professionals, including community health 
workers, doulas, and care coordinators, who 
participate in the State’s maternity care home 
model, which may include training for cultural 
competency, racial bias, health equity, reproduc-
tive and birth justice, home visiting skills, and 
respectful communication and listening skills, 
particularly in regards to maternal health; 
‘‘(D) pay for personnel and administrative 
expenses associated with designing, imple-
menting, and operating the State’s maternity 
care home model; 
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‘‘(E) pay for items and services that are 
furnished under the State’s maternity care 
home model and for which payment is otherwise 
unavailable under this title; and 
‘‘(F) pay for other costs related to the 
State’s maternity care home model, as deter-
mined by the Secretary. 
‘‘(3) GRANT
FOR
NATIONAL
INDEPENDENT 
EVALUATOR.— 
‘‘(A) IN
GENERAL.—From the amounts 
appropriated under subsection (l), prior to 
awarding any grants under paragraph (1), the 
Secretary shall enter into a contract with a na-
tional external entity to create a single, uniform 
process to— 
‘‘(i) ensure that States that receive 
grants under paragraph (1) comply with 
the requirements of this section; and 
‘‘(ii) evaluate the outcomes of the 
demonstration project in each participating 
State. 
‘‘(B) ANNUAL REPORT.—The contract de-
scribed in subparagraph (A) shall require the 
national external entity to submit to the Sec-
retary— 
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‘‘(i) a yearly evaluation report for 
each year of the demonstration project; 
and 
‘‘(ii) a final impact report after the 
demonstration project has concluded. 
‘‘(C) SECRETARY’S AUTHORITY.—Nothing 
in this paragraph shall prevent the Secretary 
from making a determination that a State is 
not in compliance with the requirements of this 
section without the national external entity 
making such a determination. 
‘‘(g) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—As a condition of receiving 
a grant under this section, a State shall enter into 
an arrangement with one or more eligible entities 
that meets the requirements of paragraph (2). 
‘‘(2) ARRANGEMENTS
WITH
ELIGIBLE
ENTI-
TIES.—Under an arrangement between a State and 
an eligible entity under this subsection, the eligible 
entity shall perform the following functions, with re-
spect to eligible individuals enrolled with the entity 
under the State’s maternity care home model— 
‘‘(A) provide culturally competent care, 
which may include prenatal care, family plan-
ning services, medical care, mental and behav-
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ioral care, postpartum care, and oral health 
care to such eligible individuals through a team 
of health care professionals, which may include 
obstetrician-gynecologists, maternal-fetal medi-
cine specialists, family physicians, primary care 
providers, oral health providers, physician as-
sistants, advanced practice registered nurses 
such as nurse practitioners and certified nurse 
midwives, certified midwives, certified profes-
sional midwives, social workers, traditional and 
community-based doulas, lactation consultants, 
childbirth educators, community health workers, 
and other health care professionals; 
‘‘(B) conduct a risk assessment of each 
such eligible individual to determine if her preg-
nancy is high or low risk, and establish a tai-
lored pregnancy care plan, which takes into 
consideration the individual’s own preferences 
and pregnancy care and birthing plans and de-
termines the appropriate support services to re-
duce the individual’s medical, social, and envi-
ronmental risk factors, for each such eligible in-
dividual based on the results of such risk as-
sessment; 
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‘‘(C) assign each such eligible individual to 
a care coordinator, which may be a nurse, social 
worker, traditional or community-based doula, 
community health worker, midwife, or other 
health care provider, who is responsible for en-
suring that such eligible individual receives the 
necessary medical care and connections to es-
sential support services; 
‘‘(D) provide, or arrange for the provision 
of, essential support services, such as services 
that address— 
‘‘(i) nutrition and exercise; 
‘‘(ii) smoking cessation; 
‘‘(iii) substance use disorder and ad-
diction treatment; 
‘‘(iv) anxiety, depression, and other 
mental and behavioral health issues; 
‘‘(v) breast feeding initiation, continu-
ation, and duration; 
‘‘(vi) housing; 
‘‘(vii) transportation; 
‘‘(viii) intimate partner violence; 
‘‘(ix) home visiting services; 
‘‘(x) childbirth education; 
‘‘(xi) oral health education; 
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