average, there are 12.7 deaths per 100,000 live 
births for White women, 43.5 deaths per 100,000 
live births for African-American women, 32.5 deaths 
for American Indian and Alaskan Native women, 
and 14.4 deaths per 100,000 live births for women 
of other ethnicities. While maternal mortality dispar-
ately impacts African-American women and indige-
nous women, this urgent public health crisis tra-
verses race, ethnicity, socioeconomic status, edu-
cational background, and geography. 
(2) United States maternal mortality rates are 
the highest in the developed world and are increas-
ing rapidly. 
(3) Many of these maternal deaths are likely 
preventable. 
(4) According to the National Institutes of 
Health, doula-assisted mothers are four times less 
likely to have a low-birth-weight baby, two times less 
likely to experience a birth complication involving 
themselves or their baby, and significantly more like-
ly to initiate breastfeeding. 
(5) Midwife-led care is associated with cost sav-
ings, decreased rates of intervention, lower cesarean 
rates, lower preterm birth rates, and healthier out-
comes for mothers and babies. 
VerDate Sep 11 2014 
04:41 May 29, 2019
Jkt 089200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2751.IH
H2751
kjohnson on DSK79L0C42 with BILLS
(6) Midwives may practice in any setting, in-
cluding the home, community, hospitals, clinics, or 
health units. 
SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY 
DOULAS AND MIDWIVES. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (29), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (30) as 
paragraph (31); and 
(C) by inserting after paragraph (29) the 
following new paragraph: 
‘‘(30) services, including prenatal, delivery, and 
postpartum services, provided by doulas and mid-
wives (as those terms are defined in subsection (ff)) 
to the extent authorized under State law; and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(ff) DOULAS AND MIDWIVES DEFINED.—For pur-
poses of subsection (a)(30): 
‘‘(1) DOULAS
DEFINED.—The term ‘doula’ 
means an individual who— 
VerDate Sep 11 2014 
04:41 May 29, 2019
Jkt 089200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2751.IH
H2751
kjohnson on DSK79L0C42 with BILLS
‘‘(A) is certified by an organization, which 
has been established for not less than five years 
and which requires the completion of continuing 
education to maintain such certification, to pro-
vide non-medical advice, information, emotional 
support, and physical comfort to an individual 
during such individual’s pregnancy, childbirth, 
and postpartum period; and 
‘‘(B) maintains such certification by com-
pleting such required continuing education. 
‘‘(2) MIDWIVES DEFINED.— 
‘‘(A) IN
GENERAL.—The term ‘midwife’ 
means a certified midwife, certified professional 
midwife, licensed midwife, and Tribal-recog-
nized midwife. 
‘‘(B) CERTIFIED MIDWIFE.—For purposes 
of subparagraph (A), the term ‘certified mid-
wife’ means an individual who is certified by the 
American Midwifery Certification Board to 
practice midwifery. 
‘‘(C) 
CERTIFIED
PROFESSIONAL
MID-
WIFE.—For purposes of subparagraph (A), the 
term ‘certified professional midwife’ means an 
individual who— 
VerDate Sep 11 2014 
04:41 May 29, 2019
Jkt 089200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2751.IH
H2751
kjohnson on DSK79L0C42 with BILLS
‘‘(i) is certified by the North Amer-
ican Registry of Midwives to practice mid-
wifery for normal, low-risk pregnancies and 
childbirths; 
‘‘(ii) completes— 
‘‘(I) a midwifery education pro-
gram accredited by the Midwifery 
Education and Accreditation Council 
or any other entity recognized by the 
Department of Education; or 
‘‘(II) the requirements to obtain 
a Midwifery Bridge Certificate from 
the North American Registry of Mid-
wives; and 
‘‘(iii) maintains the certification de-
scribed in clause (i) by completing any re-
quired continuing education for such cer-
tification. 
‘‘(D) LICENSED MIDWIFE.—For purposes 
of subparagraph (A), the term ‘licensed mid-
wife’ means, with respect to a State, an indi-
vidual who is licensed under State law to prac-
tice midwifery. 
‘‘(E) TRIBAL-RECOGNIZED MIDWIFE.—For 
purposes of subparagraph (A), the term ‘Tribal- 
VerDate Sep 11 2014 
04:41 May 29, 2019
Jkt 089200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2751.IH
H2751
kjohnson on DSK79L0C42 with BILLS
recognized midwife’ means an individual who is 
recognized by an Indian tribe (as defined in 
section 4 of the Indian Health Care Improve-
ment Act) to practice midwifery for such 
tribe.’’. 
(b) REQUIRING
MANDATORY
COVERAGE
UNDER 
STATE PLAN.—Section 1902(a)(10)(A) of the Social Se-
curity Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the 
matter preceding clause (i), by striking ‘‘and (29)’’ and 
inserting ‘‘(29), and (30)’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall apply 
with respect to medical assistance furnished on or 
after January 1, 2020. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.) that the 
Secretary of Health and Human Services determines 
requires State legislation in order for the respective 
plan to meet any requirement imposed by amend-
ments made by this section, the respective plan shall 
not be regarded as failing to comply with the re-
quirements of such title solely on the basis of its 
failure to meet such an additional requirement be-
VerDate Sep 11 2014 
04:41 May 29, 2019
Jkt 089200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2751.IH
H2751
kjohnson on DSK79L0C42 with BILLS
fore the first day of the first calendar quarter begin-
ning after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of the session shall be 
considered to be a separate regular session of the 
State legislature. 
Æ 
VerDate Sep 11 2014 
04:41 May 29, 2019
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6301
E:\BILLS\H2751.IH
H2751
kjohnson on DSK79L0C42 with BILLS