I 
119TH CONGRESS 
1ST SESSION H. R. 6303 
To improve Federal efforts with respect to the prevention of maternal 
mortality, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 25, 2025 
Ms. KELLY of Illinois introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Education and Workforce, and Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee con-
cerned 
A BILL 
To improve Federal efforts with respect to the prevention 
of maternal mortality, and for other purposes. 
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 ‘‘Community Access, 
Resources, and Empowerment for Moms Act’’ or the 
‘‘CARE for Moms Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Every year, across the United States, nearly 
4,000,000 women give birth, more than 1,000 
women suffer fatal complications during pregnancy, 
while giving birth or during the postpartum period, 
and about 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 high-income countries. The 
estimated maternal mortality rate (deaths per 
100,000 live births) for the 48 contiguous States 
and Washington, DC, increased from 14.5 percent in 
2000 to 32.0 in 2021. The United States is the only 
industrialized nation with a rising maternal mor-
tality rate. 
(3) The National Vital Statistics System of the 
Centers for Disease Control and Prevention has 
found that in 2021, there were 32.9 maternal deaths 
for every 100,000 live births in the United States. 
That ratio continues to exceed the rate in other 
high-income countries. 
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(4) It is estimated that more than 80 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 about 26.6 deaths per 100,000 live births 
for White women, 69.9 deaths per 100,000 live 
births for non-Hispanic Black women, and 32.0 
deaths per 100,000 live births for American Indian/ 
Alaska Native women. While maternal mortality dis-
parately impacts Black women, this urgent public 
health crisis traverses race, ethnicity, socioeconomic 
status, educational background, and geography. 
(6) In the United States, non-Hispanic Black 
women are about 3 times more likely to die from 
causes related to pregnancy and childbirth compared 
to non-Hispanic White women, which is one of the 
most disconcerting racial disparities in public health. 
This disparity widens in certain cities and States 
across the country. 
(7) According to the National Center for Health 
Statistics of the Centers for Disease Control and 
Prevention, the maternal mortality rate heightens 
with age, as women 40 and older die at a rate of 
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138.5 per 100,000 births compared to 20.4 per 
100,000 for women under 25. This translates to 
women over 40 being 6.8 times more likely to die 
compared to their counterparts under 25 years of 
age. 
(8) The COVID–19 pandemic has exacerbated 
the maternal health crisis. A study of the Centers 
for Disease Control and Prevention suggested that 
pregnant women are at a significantly higher risk 
for severe outcomes, including death, from COVID– 
19 as compared to non-pregnant women. The 
COVID–19 pandemic also decreased access to pre-
natal and postpartum care. A study by the Govern-
ment Accountability Office found that COVID–19 
contributed to 25 percent of maternal deaths in 
2020 and 2021. 
(9) The findings described in paragraphs (1) 
through (8) are of major concern to researchers, 
academics, members of the business community, and 
providers across the obstetric continuum represented 
by organizations such as— 
(A) the American College of Nurse-Mid-
wives; 
(B) the American College of Obstetricians 
and Gynecologists; 
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(C) the American Medical Association; 
(D) the Association of Women’s Health, 
Obstetric and Neonatal Nurses; 
(E) the Black Mamas Matter Alliance; 
(F) the Black Women’s Health Imperative; 
(G) the California Maternal Quality Care 
Collaborative; 
(H) EverThrive Illinois; 
(I) the Illinois Perinatal Quality Collabo-
rative; 
(J) the March of Dimes; 
(K) the National Association of Certified 
Professional Midwives; 
(L) RH Impact: The Collaborative for Eq-
uity and Justice; 
(M) the National Partnership for Women 
& Families; 
(N) the National Polycystic Ovary Syn-
drome Association; 
(O) the Preeclampsia Foundation; 
(P) the Society for Maternal-Fetal Medi-
cine; 
(Q) the What To Expect Project; 
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(R) Tufts University School of Medicine 
Center for Black Maternal Health and Repro-
ductive Justice; 
(S) the Shades of Blue Project; 
(T) the Maternal Mental Health Leader-
ship Alliance; 
(U) the Tulane University Mary Amelia 
Center for Women’s Health Equity Research; 
(V) In Our Own Voice: National Black 
Women’s Reproductive Justice Agenda; and 
(W) Physicians for Reproductive Health. 
(10) Hemorrhage, cardiovascular and coronary 
conditions, cardiomyopathy, infection or sepsis, em-
bolism, mental health conditions (including sub-
stance use disorder), hypertensive disorders, stroke 
and cerebrovascular accidents, and anesthesia com-
plications are the predominant medical causes of 
maternal-related deaths and complications. Most of 
these conditions are largely preventable or manage-
able. Even when these conditions are not prevent-
able, mortality and morbidity may be prevented 
when conditions are diagnosed and treated in a 
timely manner. 
(11) According to a study published by the 
Journal of Perinatal Education, doula-assisted 
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mothers are 4 times less likely to have a low-birth-
weight baby, 2 times less likely to experience a birth 
complication involving themselves or their baby, and 
significantly more likely to initiate breastfeeding and 
human lactation. Doula care has also been shown to 
produce cost savings resulting in part from reduced 
rates of cesarean and pre-term births. 
(12) Intimate partner violence is one of the 
leading causes of maternal death, and women are 
more likely to experience intimate partner violence 
during pregnancy than at any other time in their 
lives. It is also more dangerous than pregnancy. In-
timate partner violence during pregnancy and 
postpartum crosses every demographic and has been 
exacerbated by the COVID–19 pandemic. 
(13) 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 
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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. 
(14) 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. 
(15) 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, such as intimate partner violence. 
While the addition of pregnancy checkboxes on death 
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certificates since 2003 have likely improved States’ 
abilities to identify pregnancy-related deaths, they 
are not generally completed by obstetric providers or 
persons trained to recognize pregnancy-related mor-
tality. Thus, these vital forms may be missing infor-
mation or may capture 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 medical and socially determinant factors that 
contribute to such high maternal mortality rates 
within the United States compared to other devel-
oped nations. Lack of standardization of data and 
data sharing across States and between Federal en-
tities, health networks, and research institutions 
keep the Nation in the dark about ways to prevent 
maternal deaths. 
(16) Having reliable and valid State data ag-
gregated at the Federal level are critical to the Na-
tion’s ability to quell surges in maternal death and 
imperative for researchers to identify long-lasting 
interventions. 
(17) Leaders in maternal wellness highly rec-
ommend that maternal deaths and cases of maternal 
morbidity, including complications that result in 
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chronic illness and future increased risk of death, be 
investigated at the State level first, and that stand-
ardized, streamlined, de-identified data regarding 
maternal deaths be sent annually to the Centers for 
Disease Control and Prevention. Such data stand-
ardization and collection would be similar in oper-
ation and effect to the National Program of Cancer 
Registries of the Centers for Disease Control and 
Prevention and akin to the Confidential Enquiry in 
Maternal Deaths Programme in the United King-
dom. Such a maternal mortalities and morbidities 
registry and surveillance system would help pro-
viders, academicians, lawmakers, and the public to 
address questions concerning the types of, causes of, 
and best practices to thwart, maternal mortality and 
morbidity. 
(18) 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. 
(19) The United States has no comparable, co-
ordinated Federal process by which to review cases 
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of maternal mortality, systems failures, or best prac-
tices. The majority of States have active Maternal 
Mortality Review Committees (referred to in this 
section as ‘‘MMRC’’), which help leverage work to 
impact maternal wellness. For example, the State of 
California has worked extensively with their State 
health departments, health and hospital systems, 
and research collaborative organizations, including 
the California Maternal Quality Care Collaborative 
and the Alliance for Innovation on Maternal Health, 
to establish MMRCs, wherein such State has deter-
mined the most prevalent causes of maternal mor-
tality and recorded and shared data with providers 
and researchers, who have developed and imple-
mented safety bundles and care protocols related to 
preeclampsia, maternal hemorrhage, peripartum car-
diomyopathy, 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. 
(20) Hospitals and health systems across the 
United States lack standardization of emergency ob-
stetric protocols before, during, and after delivery. 
Consequently, many providers are delayed in recog-
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nizing critical signs indicating maternal distress that 
quickly escalate into fatal or near-fatal incidences. 
Moreover, any attempt to address an obstetric emer-
gency that does not consider both clinical and public 
health approaches falls woefully under the mark of 
excellent care delivery. State-based perinatal quality 
collaboratives, or entities participating in the Alli-
ance for Innovation on Maternal Health (AIM), have 
formed obstetric protocols, tool kits, and other re-
sources to improve system care and response as they 
relate to maternal complications and warning signs 
for such conditions as maternal hemorrhage, hyper-
tension, and preeclampsia. These perinatal quality 
collaboratives serve an important role in providing 
infrastructure that supports quality improvement ef-
forts addressing obstetric care and outcomes. State- 
based perinatal quality collaboratives partner with 
hospitals, physicians, nurses, midwives, patients, 
public health, and other stakeholders to provide op-
portunities for collaborative learning, rapid response 
data, and quality improvement science support to 
achieve systems-level change. 
(21) The Centers for Disease Control and Pre-
vention reports that 22 percent of deaths occurred 
during pregnancy, 25 percent occurred on the day of 
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delivery or within 7 days after the day of delivery, 
and 53 percent occurred between 7 days and 1 year 
after the day of delivery. Yet, for women eligible for 
the Medicaid program on the basis of pregnancy in 
States without Medicaid postpartum extension, such 
Medicaid coverage lapses at the end of the month on 
which the 60th postpartum day lands. 
(22) The experience of serious traumatic 
events, such as being exposed to domestic violence, 
substance use disorder, or pervasive and systematic 
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 
neurological development and other body systems, 
which can have cascading physical and mental health 
consequences, as documented in the Adverse Child-
hood Experiences study of the Centers for Disease 
Control and Prevention. 
(23) A growing body of evidence-based research 
has shown the correlation between the stress associ-
ated with systematic racism and one’s birthing out-
comes. The undue stress of sex and race discrimina-
tion paired with institutional racism has been dem-
onstrated to contribute to a higher risk of maternal 
mortality, irrespective of one’s gestational age, ma-
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ternal age, socioeconomic status, educational level, 
geographic region, or individual-level health risk fac-
tors, including poverty, limited access to prenatal 
care, and poor physical and mental health (although 
these are not nominal factors). Black women remain 
the most at risk for pregnancy-associated or preg-
nancy-related causes of death. When it comes to 
preeclampsia, for example, for which obesity is a risk 
factor, Black women of normal weight remain at a 
higher at risk of dying during the perinatal period 
compared to non-Black obese women. 
(24) The rising maternal mortality rate in the 
United States is driven predominantly by the dis-
proportionately high rates of Black maternal mor-
tality. 
(25) Compared to women from other racial and 
ethnic demographics, Black women across the socio-
economic spectrum experience prolonged, unrelenting 
stress related to systematic racial and gender dis-
crimination, contributing to higher rates of maternal 
mortality, giving birth to low-weight babies, and ex-
periencing pre-term birth. Racism is a risk-factor for 
these aforementioned experiences. This cumulative 
stress, called weathering, often extends across the 
life course and is situated in everyday spaces where 
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Black women establish livelihood. Systematic racism, 
structural barriers, lack of access to quality mater-
nal health care, lack of access to nutritious food, and 
social determinants of health exacerbate Black wom-
en’s likelihood to experience poor or fatal birthing 
outcomes, but do not fully account for the great dis-
parity. 
(26) Black women are twice as likely to experi-
ence postpartum depression, and disproportionately 
higher rates of preeclampsia compared to White 
women. 
(27) Racism is deeply ingrained in United 
States systems, including in health care delivery sys-
tems between patients and providers, often resulting 
in disparate treatment for pain, irreverence for cul-
tural 
norms 
with 
respect 
to 
health, 
and 
dismissiveness. However, the provider pool is not 
primed with many people of color, nor are providers 
(whether maternity care clinicians or maternity care 
support personnel) consistently required to undergo 
implicit bias, cultural competency, respectful care 
practices, or empathy training on a consistent, on- 
going basis. 
(28) Women are not the only people who can 
become 
pregnant 
or 
give 
birth. 
Nonbinary, 
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transgender, and gender-expansive people can also 
become pregnant. The terms ‘‘birthing people’’ or 
‘‘birthing persons’’ are also used to describe preg-
nant or postpartum people in a way that is inclusive 
of individuals who experience gender beyond the bi-
nary. 
(29) Substance misuse among pregnant women, 
including the use of substances that are illegal or 
criminalized, misuse of prescribed medications, and 
binge drinking, has increased year after year for the 
past decade. Pregnant people with Substance Use 
Disorder, particularly those with opioids, amphet-
amines, and cocaine use disorders, are at greater 
risk of severe maternal morbidity, including condi-
tions such as eclampsia, heart attack or failure, and 
sepsis. 
SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO 
PREVENTION OF MATERNAL MORTALITY. 
(a) FUNDING FOR STATE-BASED PERINATAL QUAL-
ITY
COLLABORATIVES
DEVELOPMENT
AND
SUSTAIN-
ABILITY.— 
(1) 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 
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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 grant program under 
which the Secretary awards grants to eligible entities 
for the purpose of development and sustainability of 
perinatal quality collaboratives in every State, the 
District of Columbia, and eligible territories, in 
order to measurably improve perinatal care and 
perinatal 
health 
outcomes 
for 
pregnant 
and 
postpartum women and their infants. 
(2) GRANT AMOUNTS.—Grants awarded under 
this subsection shall be in amounts not to exceed 
$250,000 per year, for the duration of the grant pe-
riod. 
(3) STATE-BASED
PERINATAL
QUALITY
COL-
LABORATIVE DEFINED.—For purposes of this sub-
section, the term ‘‘State-based perinatal quality col-
laborative’’ means a network of teams that— 
(A) is multidisciplinary in nature and in-
cludes the full range of perinatal and maternity 
care providers; 
(B) works to improve measurable outcomes 
for maternal and infant health by advancing 
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evidence-informed clinical practices using qual-
ity improvement principles; 
(C) works with hospital-based or out-
patient facility-based clinical teams, experts, 
and stakeholders, including patients and fami-
lies, to spread best practices and optimize re-
sources to improve perinatal care and outcomes; 
(D) employs strategies that include the use 
of the collaborative learning model to provide 
opportunities for hospitals and clinical teams to 
collaborate on improvement strategies, rapid-re-
sponse data to provide timely feedback to hos-
pital and other clinical teams to track progress, 
and quality improvement science to provide sup-
port and coaching to hospital and clinical 
teams; 
(E) has the goal of improving population- 
level outcomes in maternal and infant health; 
and 
(F) has the goal of improving outcomes of 
all birthing people, through the coordination, 
integration, and collaboration across birth set-
tings. 
(4) AUTHORIZATION OF APPROPRIATIONS.—For 
purposes of carrying out this subsection, there is au-
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thorized to be appropriated $35,000,000 per year 
for each of fiscal years 2026 through 2030. 
(b) EXPANSION OF MEDICAID AND CHIP COVERAGE 
FOR PREGNANT AND POSTPARTUM WOMEN.— 
(1) REQUIRING COVERAGE OF ORAL HEALTH 
SERVICES
FOR
PREGNANT
AND
POSTPARTUM 
WOMEN.— 
(A) MEDICAID.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d) is amend-
ed— 
(i) in subsection (a)(4)— 
(I) by striking ‘‘; and (D)’’ and 
inserting ‘‘; (D)’’; 
(II) by striking ‘‘; and (E)’’ and 
inserting ‘‘; (E)’’; 
(III) by striking ‘‘; and (F)’’ and 
inserting ‘‘; (F)’’; and 
(IV) by striking the semicolon at 
the end and inserting ‘‘; and (G) oral 
health services for pregnant and 
postpartum women (as defined in sub-
section (jj));’’; and 
(ii) by adding at the end the following 
new subsection: 
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‘‘(jj) 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 
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.’’. 
(B) CHIP.—Section 2103(c)(6) of the So-
cial Security Act (42 U.S.C. 1397cc(c)(6)) is 
amended— 
(i) in subparagraph (A)— 
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(I) by inserting ‘‘or a targeted 
low-income pregnant woman’’ after 
‘‘targeted low-income child’’; and 
(II) by inserting ‘‘, and, in the 
case of a targeted low-income child 
who is pregnant or a targeted low-in-
come pregnant woman, satisfy the 
coverage requirements specified in 
section 1905(jj)’’ after ‘‘emergency 
conditions’’; and 
(ii) in subparagraph (B), by inserting 
‘‘(but only if, in the case of a targeted low- 
income child who is pregnant or a targeted 
low-income pregnant woman, the bench-
mark dental benefit package satisfies the 
coverage requirements specified in section 
1905(jj))’’ after ‘‘subparagraph (C)’’. 
(2) REQUIRING
12-MONTH
CONTINUOUS
COV-
ERAGE
OF
FULL
BENEFITS
FOR
PREGNANT
AND 
POSTPARTUM
INDIVIDUALS
UNDER
MEDICAID
AND 
CHIP.— 
(A) MEDICAID.—Section 1902 of the So-
cial Security Act (42 U.S.C. 1396a) is amend-
ed— 
(i) in subsection (a)— 
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(ii) in paragraph (86), by striking 
‘‘and’’ at the end; 
(iii) in paragraph (87), by striking the 
period at the end and inserting ‘‘; and’’; 
and 
(iv) by inserting after paragraph (87) 
the following new paragraph: 
‘‘(88) provide that the State plan is in compli-
ance with subsection (e)(16).’’; and 
(v) in subsection (e)(16)— 
(I) in subparagraph (A), by strik-
ing ‘‘At the option of the State, the 
State plan (or waiver of such State 
plan) may provide’’ and inserting ‘‘A 
State plan (or waiver of such State 
plan) shall provide’’; 
(II) in subparagraph (B), in the 
matter preceding clause (i), by strik-
ing ‘‘by a State making an election 
under this paragraph’’ and inserting 
‘‘under a State plan (or a waiver of 
such State plan)’’; and 
(III) by striking subparagraph 
(C). 
(B) CHIP.— 
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(i) 
IN
GENERAL.—Section 
2107(e)(1)(J) of the Social Security Act 
(42 U.S.C. 1397gg(e)(1)(J)), as inserted 
by section 9822 of the American Rescue 
Plan Act of 2021 (Public Law 117–2), is 
amended to read as follows: 
‘‘(J) Paragraphs (5) and (16) of section 
1902(e) (relating to the requirement to provide 
medical assistance under the State plan or 
waiver consisting of full benefits during preg-
nancy 
and 
throughout 
the 
12-month 
postpartum period under title XIX).’’. 
(ii) CONFORMING AMENDMENT.—Sec-
tion 2112(d)(2)(A) of the Social Security 
Act (42 U.S.C. 1397ll(d)(2)(A)) is amend-
ed by striking ‘‘the month in which the 60- 
day period’’ and all that follows through 
‘‘pursuant to section 2107(e)(1),’’. 
(3) MAINTENANCE OF EFFORT.— 
(A) MEDICAID.—Section 1902(l) of the So-
cial Security Act (42 U.S.C. 1396a(l)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(5) During the period that begins on the date of 
enactment of this paragraph and ends on the date that 
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is 5 years after such date of enactment, as a condition 
for receiving any Federal payments under section 1903(a) 
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.’’. 
(B) CHIP.—Section 2105(d) of the Social 
Security Act (42 U.S.C. 1397ee(d)) is amended 
by adding at the end the following new para-
graph: 
‘‘(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 5 years 
after such date of enactment, as a condition of re-
ceiving payments under subsection (a) and section 
1903(a), a State that elects to provide assistance to 
women on the basis of being pregnant (including 
pregnancy-related assistance provided to targeted 
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low-income pregnant women (as defined in section 
2112(d)), pregnancy-related assistance provided 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 preg-
nant) shall not have in effect, with respect to such 
women, eligibility standards, methodologies, or pro-
cedures under such plan (or waiver) that are more 
restrictive than the eligibility standards, methodolo-
gies, or procedures, respectively, under such plan (or 
waiver) that are in effect on the date of enactment 
of this paragraph.’’. 
(4) INFORMATION
ON
BENEFITS.—The Sec-
retary of Health and Human Services shall make 
publicly available on the internet website of the De-
partment of Health and Human Services, informa-
tion regarding benefits available to pregnant and 
postpartum women and under the Medicaid program 
and the Children’s Health Insurance Program, in-
cluding information on— 
(A) benefits that States are required to 
provide to pregnant and postpartum women 
under such programs; 
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(B) optional benefits that States may pro-
vide to pregnant and postpartum women under 
such programs; and 
(C) the availability of different kinds of 
benefits for pregnant and postpartum women, 
including oral health and mental health benefits 
and breastfeeding services and supplies, under 
such programs. 
(5) FEDERAL
FUNDING
FOR
COST
OF
EX-
TENDED
MEDICAID
AND
CHIP
COVERAGE
FOR 
POSTPARTUM WOMEN.— 
(A) MEDICAID.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d), as amend-
ed by paragraph (1), is further amended by 
adding at the end the following: 
‘‘(kk) INCREASED FMAP FOR EXTENDED MEDICAL 
ASSISTANCE FOR POSTPARTUM INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), the Federal medical assistance percentage for a 
State, with respect to amounts expended by such 
State for medical assistance for an individual who is 
eligible for such assistance on the basis of being 
pregnant or having been pregnant that is provided 
during the 305-day period that begins on the 60th 
day after the last day of the individual’s pregnancy 
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(including any such assistance provided during the 
month in which such period ends), shall be equal 
to— 
‘‘(A) during the first 20-quarter period for 
which this subsection is in effect with respect to 
a State, 100 percent; and 
‘‘(B) with respect to a State, during each 
quarter thereafter, 90 percent. 
‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 
Any payment made to a territory for expenditures 
for medical assistance for an individual described in 
paragraph (1) that is subject to the Federal medical 
assistance percentage specified under paragraph (1) 
shall not be taken into account for purposes of ap-
plying payment limits under subsections (f) and (g) 
of section 1108.’’. 
(B) CHIP.—Section 2105(c) of the Social 
Security Act (42 U.S.C. 1397ee(c)) is amended 
by adding at the end the following new para-
graph: 
‘‘(13) 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 
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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 
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) during the first 20-quarter period for 
which this subsection is in effect with respect to 
a State, 100 percent; and 
‘‘(B) with respect to a State, during each 
quarter thereafter, 90 percent.’’. 
(6) GUIDANCE ON STATE OPTIONS FOR MED-
ICAID COVERAGE OF DOULA SERVICES.—Not later 
than 1 year after the date of the enactment of this 
Act, the Secretary of Health and Human Services 
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shall issue guidance for the States concerning op-
tions for Medicaid coverage and payment for support 
services provided by doulas. 
(7) ENHANCED FMAP FOR RURAL OBSTETRIC 
AND GYNECOLOGICAL SERVICES.—Section 1905 of 
the Social Security Act (42 U.S.C. 1396d), as 
amended by paragraphs (1) and (5), is further 
amended— 
(A) in subsection (b), by striking ‘‘and 
(ii)’’ and inserting ‘‘(ii), (jj), (kk), and (ll)’’; 
and 
(B) by adding at the end the following new 
subsection: 
‘‘(ll) INCREASED FMAP FOR MEDICAL ASSISTANCE 
FOR OBSTETRIC AND GYNECOLOGICAL SERVICES FUR-
NISHED AT RURAL HOSPITALS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), the Federal medical assistance percentage for a 
State, with respect to amounts expended by such 
State for medical assistance for obstetric or gyneco-
logical services that are furnished in a hospital that 
is located in a rural area (as defined for purposes 
of section 1886) shall be equal to 90 percent for 
each calendar quarter beginning with the first cal-
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endar quarter during which this subsection is in ef-
fect. 
‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 
Any payment made to a territory for expenditures 
for medical assistance described in paragraph (1) 
that is subject to the Federal medical assistance per-
centage specified under paragraph (1) shall not be 
taken into account for purposes of applying payment 
limits under subsections (f) and (g) of section 
1108.’’. 
(8) EFFECTIVE DATES.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C)— 
(i) the amendments made by para-
graphs (1), (2), and (5) shall take effect 
on the first day of the first calendar quar-
ter that begins on or after the date that is 
1 year after the date of enactment of this 
Act; 
(ii) the amendments made by para-
graph (3) shall take effect on the date of 
enactment of this Act; and 
(iii) the amendments made by para-
graph (7) shall take effect on the first day 
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of the first calendar quarter that begins on 
or after the date of enactment of this Act. 
(B) 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 such Act that 
the Secretary of Health and Human Services 
determines requires State legislation in order 
for the respective plan to meet any requirement 
imposed by amendments made by this sub-
section, the respective plan shall not be re-
garded as failing to comply with the require-
ments of such title solely on the basis of its fail-
ure to meet such an additional requirement be-
fore the first day of the first calendar quarter 
beginning after the close of the first regular 
session of the State legislature that begins after 
the date of enactment of this Act. For purposes 
of the previous sentence, in the case of a State 
that has a 2-year legislative session, each year 
of the session shall be considered to be a sepa-
rate regular session of the State legislature. 
(C) STATE OPTION FOR EARLIER EFFEC-
TIVE DATE.—A State may elect to have sub-
section (e)(16) of section 1902 of the Social Se-
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curity Act (42 U.S.C. 1396a) and subparagraph 
(J) of section 2107(e)(1) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)), as amended by 
paragraph (2), and subsection (kk) of section 
1905 of the Social Security Act (42 U.S.C. 
1396d) and paragraph (13) of section 2105(c) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397ee(c)), as added by paragraph (5), take ef-
fect with respect to the State on the first day 
of any fiscal quarter that begins before the date 
described in subparagraph (A) and apply to 
amounts payable to the State for expenditures 
for medical assistance, child health assistance, 
or pregnancy-related assistance to pregnant or 
postpartum individuals furnished on or after 
such day. 
(c) REGIONAL CENTERS OF EXCELLENCE.—Part P 
of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the fol-
lowing: 
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‘‘SEC. 399V–8. REGIONAL CENTERS OF EXCELLENCE AD-
DRESSING IMPLICIT BIAS AND CULTURAL 
COMPETENCY IN PATIENT-PROVIDER INTER-
ACTIONS EDUCATION. 
‘‘(a) IN GENERAL.—Not later than one year after the 
date of enactment of this section, the Secretary, in con-
sultation with such other agency heads as the Secretary 
determines appropriate, shall award cooperative agree-
ments for the establishment or support of regional centers 
of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider inter-
actions education for the purpose of enhancing and im-
proving how health care professionals are educated in im-
plicit bias and delivering culturally competent health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper-
ative agreement under subsection (a), an entity shall— 
‘‘(1) be a public or other nonprofit entity speci-
fied by the Secretary that provides educational and 
training opportunities for students and health care 
professionals, which may be a health system, teach-
ing hospital, community health center, medical 
school, school of public health, school of nursing, 
dental school, social work school, school of profes-
sional psychology, or any other health professional 
school or program at an institution of higher edu-
cation (as defined in section 101 of the Higher Edu-
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cation Act of 1965) focused on the prevention, treat-
ment, or recovery of health conditions that con-
tribute to maternal mortality and the prevention of 
maternal mortality and severe maternal morbidity; 
‘‘(2) demonstrate community engagement and 
participation, such as through partnerships with 
home visiting and case management programs or 
community-based organizations serving minority 
populations; 
‘‘(3) demonstrate engagement with groups en-
gaged in the implementation of health care profes-
sional training in implicit bias and delivering cul-
turally competent care, such as departments of pub-
lic health, perinatal quality collaboratives, hospital 
systems, and health care professional groups, in 
order to obtain input on resources needed for effec-
tive implementation strategies; and 
‘‘(4) provide to the Secretary such information, 
at such time and in such manner, as the Secretary 
may require. 
‘‘(c) DIVERSITY.—In awarding a cooperative agree-
ment under subsection (a), the Secretary shall take into 
account any regional differences among eligible entities 
and make an effort to ensure geographic diversity among 
award recipients. 
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‘‘(d) DISSEMINATION OF INFORMATION.— 
‘‘(1) PUBLIC
AVAILABILITY.—The Secretary 
shall make publicly available on the internet website 
of the Department of Health and Human Services 
information submitted to the Secretary under sub-
section (b)(3). 
‘‘(2) EVALUATION.—The Secretary shall evalu-
ate each regional center of excellence established or 
supported pursuant to subsection (a) and dissemi-
nate the findings resulting from each such evalua-
tion to the appropriate public and private entities. 
‘‘(3) DISTRIBUTION.—The Secretary shall share 
evaluations and overall findings with State depart-
ments of health and other relevant State level offices 
to inform State and local best practices. 
‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec-
tion, the term ‘maternal mortality’ means death of a 
woman that occurs during pregnancy or within the one- 
year period following the end of such pregnancy. 
‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—For 
purposes of carrying out this section, there is authorized 
to be appropriated $5,000,000 for each of fiscal years 
2026 through 2030.’’. 
(d) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM 
FOR
WOMEN, 
INFANTS, 
AND
CHILDREN.—Section 
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17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42 
U.S.C. 1786(d)(3)(A)(ii)) is amended— 
(1) by striking the clause designation and head-
ing and all that follows through ‘‘A State’’ and in-
serting the following: 
‘‘(ii) WOMEN.— 
‘‘(I) BREASTFEEDING WOMEN.— 
A State’’; 
(2) in subclause (I) (as so designated), by strik-
ing ‘‘1 year’’ and all that follows through ‘‘earlier’’ 
and inserting ‘‘2 years postpartum’’; and 
(3) by adding at the end the following: 
‘‘(II) POSTPARTUM
WOMEN.—A 
State 
may 
elect 
to 
certify 
a 
postpartum woman for a period of 2 
years.’’. 
(e) DEFINITION OF MATERNAL MORTALITY.—In this 
section, the term ‘‘maternal mortality’’ means death of a 
woman that occurs during pregnancy or within the one- 
year period following the end of such pregnancy. 
SEC. 4. FULL SPECTRUM DOULA WORKFORCE. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish and implement a program 
to award grants or contracts to health professions schools, 
schools of public health, academic health centers, State or 
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local governments, territories, Indian Tribes and Tribal 
organizations, Urban Indian organizations, Native Hawai-
ian organizations, community-based organizations, or 
other appropriate public or private nonprofit entities (or 
consortia of any such entities, including entities promoting 
multidisciplinary approaches), to establish or expand pro-
grams to grow and diversify the doula workforce, including 
through improving the capacity and supply of health care 
providers. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Establishing programs that provide edu-
cation and training to individuals seeking appro-
priate training or certification as full spectrum 
doulas. 
(2) Expanding the capacity of existing pro-
grams described in paragraph (1), for the purpose of 
increasing the number of students enrolled in such 
programs, including by awarding scholarships for 
students who agree to work in underserved commu-
nities after receiving such education and training. 
(3) Developing and implementing strategies to 
recruit and retain students from underserved com-
munities, particularly from demographic groups ex-
periencing high rates of maternal mortality and se-
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vere maternal morbidity, including racial and ethnic 
minority groups, into programs described in para-
graphs (1) and (2). 
(c) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Secretary for fiscal 
year 2026, out of any money in the Treasury not otherwise 
appropriated, $50,000,000, to remain available until ex-
pended, for carrying out this section. 
SEC. 5. GRANTS FOR RURAL OBSTETRIC MOBILE HEALTH 
UNITS. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 320C. GRANTS FOR RURAL OBSTETRIC MOBILE 
HEALTH UNITS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration (referred to in this section as the ‘Sec-
retary’), shall establish a pilot program under which the 
Secretary shall make grants to States— 
‘‘(1) to purchase and equip rural mobile health 
units for the purpose of providing pre-conception, 
pregnancy, postpartum, and obstetric emergency 
services in rural and underserved communities; 
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‘‘(2) to train providers including obstetrician- 
gynecologists, certified nurse-midwives, nurse practi-
tioners, nurses, and midwives to operate and provide 
obstetric services, including training and planning 
for obstetric emergencies, in such mobile health 
units; and 
‘‘(3) to address access issues, including social 
determinants of health and wrap-around clinical and 
community services including nutrition, housing, lac-
tation services, and transportation support and re-
ferrals. 
‘‘(b) NO SHARING OF DATA WITH LAW ENFORCE-
MENT.—As a condition of receiving a grant under this sec-
tion, a State shall submit to the Secretary an assurance 
that the State will not make available to Federal or State 
law enforcement any personally identifiable information 
regarding any pregnant or postpartum individual collected 
pursuant to such grant. 
‘‘(c) GRANT DURATION.—The period of a grant 
under this section shall not exceed 5 years. 
‘‘(d) IMPLEMENTING AND REPORTING.— 
‘‘(1) IN
GENERAL.—States that receive pilot 
grants under this section shall be responsible for— 
‘‘(A) implementing the program funded by 
the pilot grants; and 
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‘‘(B) not later than 3 years after the date 
of enactment of this Act, and 6 years after the 
date of enactment of this Act, submitting a re-
port containing the results of such program to 
the Secretary, including— 
‘‘(i) relevant information and relevant 
quantitative indicators of the programs’ 
success in improving the standard of care 
and maternal health outcomes for individ-
uals in rural and underserved communities 
seen for pre-conception, pregnancy, or 
postpartum visits in the rural mobile 
health units, stratified by the categories of 
data specified in paragraph (2); 
‘‘(ii) relevant qualitative evaluations 
from individuals receiving pre-conception, 
pregnant, or postpartum care from rural 
mobile health units, including measures of 
patient-reported experience of care and 
measures of patient-reported issues with 
access to care without the rural mobile 
health unit pilot; and 
‘‘(iii) strategies to sustain such pro-
grams beyond the duration of the grant 
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and expand such programs to other rural 
and underserved communities. 
‘‘(2) CATEGORIES OF DATA.—The categories of 
data specified in this paragraph are the following: 
‘‘(A) Race, ethnicity, sex, gender, gender 
identity, primary language, age, geography, dis-
ability status, and insurance status. 
‘‘(B) Number of visits provided for pre-
conception, prenatal, or postpartum care. 
‘‘(C) Number of repeat visits provided for 
preconception, prenatal, or postpartum care. 
‘‘(D) Number of screenings or tests pro-
vided for smoking, substance use, hypertension, 
sexually transmitted diseases, diabetes, HIV, 
depression, intimate partner violence, Pap 
smears, and pregnancy. 
‘‘(3) DATA PRIVACY PROTECTION.—The reports 
referred to in paragraph (1)(B) shall not contain 
any personally identifiable information regarding 
any pregnant or postpartum individual. 
‘‘(e) EVALUATION.—The Secretary shall conduct an 
evaluation of the pilot program under this section to deter-
mine the impact of the pilot program with respect to— 
‘‘(1) the effectiveness of the grants awarded 
under this section to improve maternal health out-
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comes in rural and underserved communities, with 
data stratified by race, ethnicity, primary language, 
socioeconomic status, geography, insurance type, and 
other factors as the Secretary determines appro-
priate; 
‘‘(2) spending on maternity care by States par-
ticipating in the pilot program; 
‘‘(3) to the extent practicable, qualitative, and 
quantitative measures of patient experience; and 
‘‘(4) any other areas of assessment that the 
Secretary determines relevant. 
‘‘(f) REPORT.—Not later than one year after the 
completion of the pilot program under this section, the 
Secretary shall submit to the Congress, and make publicly 
available, a report containing— 
‘‘(1) the results of any evaluation conducted 
under subsection (e); and 
‘‘(2) a recommendation regarding whether the 
pilot program should be continued after fiscal year 
2030 and expanded on a national basis. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to the Secretary to carry 
out this section $10,000,000 for each of fiscal years 2026 
through 2030.’’. 
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‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 
tobacco, and roll-your-own tobacco, and 
‘‘(2) any other product subject to tax pursuant 
to section 5701(i).’’. 
(2) CONFORMING
AMENDMENTS.—Subsection 
(d) of section 5702 of such Code is amended by 
striking ‘‘cigars, cigarettes, smokeless tobacco, pipe 
tobacco, or roll-your-own tobacco’’ each place it ap-
pears and inserting ‘‘tobacco products’’. 
(i) INCREASING TAX ON CIGARETTES.— 
(1) SMALL
CIGARETTES.—Section 5701(b)(1) 
of such Code is amended by striking ‘‘$50.33’’ and 
inserting ‘‘$100.66’’. 
(2) LARGE
CIGARETTES.—Section 5701(b)(2) 
of such Code is amended by striking ‘‘$105.69’’ and 
inserting ‘‘$211.38’’. 
(j) TAX RATES ADJUSTED FOR INFLATION.—Section 
5701 of such Code, as amended by subsection (g), is 
amended by adding at the end the following new sub-
section: 
‘‘(j) INFLATION ADJUSTMENT.— 
‘‘(1) IN GENERAL.—In the case of any calendar 
year beginning after 2025, the dollar amounts pro-
vided under this chapter shall each be increased by 
an amount equal to— 
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