IIB 
116TH CONGRESS 
2D SESSION 
H. R. 4996 
IN THE SENATE OF THE UNITED STATES 
SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2020 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To amend title XIX of the Social Security Act to provide 
for a State option under the Medicaid program to provide 
for and extend continuous coverage for certain individ-
uals, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Helping Medicaid 
Offer Maternity Services Act of 2020’’ or the ‘‘Helping 
MOMS Act of 2020’’. 
SEC. 2. MODIFICATIONS TO CERTAIN COVERAGE UNDER 
MEDICAID AND CHIP FOR PREGNANT AND 
POSTPARTUM WOMEN. 
(a) STATE OPTION.—Section 1902(e) of the Social 
Security Act (42 U.S.C. 1396a(e)) is amended by adding 
at the end the following new paragraph: 
‘‘(16) EXTENDING
CERTAIN
COVERAGE
FOR 
PREGNANT AND POSTPARTUM WOMEN.—At the op-
tion of the State, the State plan (or waiver of such 
State plan) may provide that an individual who, 
while pregnant, is eligible for and has received med-
ical assistance under the State plan approved under 
this title (or waiver of such plan) (including during 
a period of retroactive eligibility under subsection 
(a)(34)) shall, in addition to remaining eligible 
under paragraph (5) for all pregnancy-related and 
postpartum medical assistance available under the 
State plan (or wavier) through the last day of the 
month in which the 60-day period (beginning on the 
last day of her pregnancy) ends, remain eligible 
under the State plan (or waiver) for medical assist-
ance and such medical assistance shall include all 
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services covered under the State plan (or waiver) 
that is not less in amount, duration, or scope, or is 
determined by the Secretary to be substantially 
equivalent, to the medical assistance available for an 
individual described in subsection (a)(10)(A)(i) for 
the period beginning on the first day occurring after 
the end of such 60-day period and ending on the last 
day of the month in which the one-year period (be-
ginning on the last day of her pregnancy) ends.’’. 
(b) APPLICATION TO CHIP.— 
(1) IN
GENERAL.—Section 2107(e)(1) of the 
Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(A) by redesignating subparagraphs (J) 
through (S) as subparagraphs (K) through (T), 
respectively; and 
(B) by inserting after subparagraph (I) the 
following new subparagraph: 
‘‘(J) In the case of a State that has elected 
to apply the option under section 1902(e)(16) 
with respect to coverage for pregnant and 
postpartum women under title XIX, the provi-
sions of such section with respect to coverage of 
pregnant and postpartum women under this 
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title, except that such coverage shall be required 
and not at the option of the State.’’. 
(2) OPTIONAL COVERAGE OF TARGETED LOW- 
INCOME PREGNANT WOMEN.—Section 2112(d)(2)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397ll(d)(2)(A)) is amended by inserting after ‘‘60- 
day period’’ the following: ‘‘, or, in the case that sec-
tion 1902(e)(16) applies to the State child health 
plan (or waiver of such plan) pursuant to section 
2107(e)(1), the 1-year period’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to State elections 
made under paragraph (16) of section 1902(e) of the So-
cial Security Act (42 U.S.C. 1396a(e)), as added by sub-
section (a), under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) on or after the first day of the first 
fiscal year quarter beginning at least one year after the 
date of the enactment of this Act. 
SEC. 3. MACPAC REPORT. 
(a) IN GENERAL.—Not later than 1 year after the 
date of the enactment of this Act, the Medicaid and CHIP 
Payment and Access Commission (referred to in this sec-
tion as ‘‘MACPAC’’) shall publish a report on the coverage 
of doula services under State Medicaid programs, which 
shall at a minimum include the following: 
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(1) Information about coverage for doula serv-
ices under State Medicaid programs that currently 
provide coverage for such services, including the type 
of doula services offered (such as prenatal, labor and 
delivery, postpartum support, and also community- 
based and traditional doula services). 
(2) An analysis of barriers to covering doula 
services under State Medicaid programs. 
(3) An identification of effective strategies to 
increase the use of doula services in order to provide 
better care and achieve better maternal and infant 
health outcomes, including strategies that States 
may use to recruit, train, and certify a diverse doula 
workforce, particularly from underserved commu-
nities, communities of color, and communities facing 
linguistic or cultural barriers. 
(4) Recommendations for legislative and admin-
istrative actions to increase access to doula services 
in State Medicaid programs, including actions that 
ensure doulas may earn a living wage that accounts 
for their time and costs associated with providing 
care. 
(b) STAKEHOLDER CONSULTATION.—In developing 
the report required under subsection (a), MACPAC shall 
consult with relevant stakeholders, including— 
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(1) States; 
(2) organizations representing consumers, in-
cluding those that are disproportionately impacted 
by poor maternal health outcomes; 
(3) organizations and individuals representing 
doula services providers, including community-based 
doula programs and those who serve underserved 
communities, including communities of color, and 
communities facing linguistic or cultural barriers; 
and 
(4) organizations representing health care pro-
viders. 
SEC. 4. GAO REPORT. 
(a) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act and every five years 
thereafter, the Comptroller General of the United States 
shall submit to Congress a report on the State adoption, 
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 such Act, 
of extending coverage to 365 days postpartum pursuant 
to the provisions of (and amendments made by this Act). 
Such report shall include the information and rec-
ommendations described in subsection (b) and shall also 
identify ongoing gaps in coverage for— 
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(1) pregnant women under the Medicaid pro-
gram and the Children’s Health Insurance Program; 
and 
(2) postpartum women under the Medicaid pro-
gram and the Children’s Health Insurance Program 
who received assistance under either such program 
during their pregnancy. 
(b) CONTENT OF REPORT.—The report under sub-
section (a) shall include the following: 
(1) Information regarding the extent to which 
States have elected to extend coverage to 365 days 
postpartum pursuant to the provisions of (and 
amendments made by this Act), including which 
States make the election and when, impacts on 
perinatal insurance churn in those States compared 
to States that did not make such election, other 
health impacts of such election including regarding 
maternal mortality and morbidity rates, and impacts 
on State and Federal Medicaid spending. 
(2) Information about the abilities, successes, 
and challenges of State Medicaid agencies in— 
(A) transitioning their eligibility systems to 
incorporate such an election by a State and in 
determining whether pregnant and postpartum 
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women are eligible under another insurance af-
fordability program; and 
(B) transitioning any such women who are 
so eligible to coverage under such a program, 
pursuant to section 1943(b)(3) of the Social Se-
curity Act (42 U.S.C 1396w–3(b)(3)). 
(3) Information on factors contributing to ongo-
ing gaps in coverage resulting from women 
transitioning from coverage under the Medicaid pro-
gram or Children’s Health Insurance Program that 
disproportionately impact underserved populations, 
including low-income 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 
Service 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))). 
(4) Recommendations for addressing and reduc-
ing such gaps in coverage. 
(5) Such other information as the Comptroller 
General determines appropriate. 
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SEC. 5. REPORT ON MEDICAID BUNDLED PAYMENTS FOR 
PREGNANCY-RELATED SERVICES. 
Not later than 2 years after the date of the enact-
ment of this Act, the Medicaid and CHIP Payment Advi-
sory Commission shall submit to Congress a report con-
taining an analysis of the use of bundled payments for 
reimbursing health care providers with respect to preg-
nancy-related services furnished under State plans (or 
waivers of such plans) under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.). 
SEC. 6. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT 
FOR SINGLE SOURCE DRUGS AND INNO-
VATOR MULTIPLE SOURCE DRUGS. 
Section 1927(c)(2)(D) of the Social Security Act (42 
U.S.C. 1396r–8(c)(2)(D)) is amended by inserting after 
‘‘December 31, 2009,’’ the following: ‘‘and before January 
1, 2023,’’. 
SEC. 7. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(3) of the Social Security Act (42 
U.S.C 1396w–1(b)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘for fiscal 
year 2025 and thereafter, $1,960,000,000’’ and in-
serting ‘‘for fiscal year 2022 and thereafter, 
$9,286,000,000’’; and 
(2) in subparagraph (B), by striking ‘‘fiscal 
year 2025’’ and inserting ‘‘fiscal year 2022’’. 
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SEC. 8. DETERMINATION OF BUDGETARY EFFECTS. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 
Act, submitted for printing in the Congressional Record 
by the Chairman of the House Budget Committee, pro-
vided that such statement has been submitted prior to the 
vote on passage. 
Passed the House of Representatives September 29, 
2020. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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