IB 
Union Calendar No. 428 
116TH CONGRESS 
2D SESSION 
H. R. 4996 
[Report No. 116–527] 
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 cov-
erage for certain individuals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 8, 2019 
Ms. KELLY of Illinois (for herself, Mr. BURGESS, Ms. UNDERWOOD, Mrs. 
RODGERS of Washington, Ms. PRESSLEY, and Mr. CARTER of Georgia) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
SEPTEMBER 21, 2020 
Additional sponsors: Ms. HERRERA BEUTLER, Mr. WALDEN, Mr. ENGEL, 
Mrs. HAYES, Mr. TRONE, Mr. CRENSHAW, Mr. GUTHRIE, Mr. RUIZ, Ms. 
SCHAKOWSKY, Mr. FITZPATRICK, Mr. CUNNINGHAM, Ms. NORTON, Mr. 
LARSEN of Washington, Mr. CLAY, Mr. MCGOVERN, Ms. KENDRA S. 
HORN of Oklahoma, Ms. FINKENAUER, Mrs. AXNE, Ms. SHALALA, Mr. 
WALBERG, Mr. MCEACHIN, Mrs. FLETCHER, Mrs. BUSTOS, Mr. VAN 
DREW, Ms. JACKSON LEE, Ms. DEAN, Mr. LAMB, Mrs. DAVIS of Cali-
fornia, Ms. PORTER, Mrs. NAPOLITANO, and Ms. HOULAHAN 
SEPTEMBER 21, 2020 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
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[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on November 8, 2019] 
A BILL 
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. 
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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 ‘‘Helping Medicaid Offer 
Maternity Services Act of 2019’’ or the ‘‘Helping MOMS 
Act of 2019’’. 
SEC. 2. STATE OPTION UNDER MEDICAID PROGRAM TO 
PROVIDE FOR AND EXTEND CONTINUOUS 
COVERAGE FOR CERTAIN INDIVIDUALS. 
(a) STATE OPTION TO EXTEND CONTINUOUS COV-
ERAGE FOR PREGNANT AND POSTPARTUM INDIVIDUALS.— 
Title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) is amended— 
(1) in section 1902(e)(5), by inserting after ‘‘60- 
day period’’ the following: ‘‘or, at the option of the 
State, 1-year period’’; 
(2) in section 1902(e)(6), by inserting after ‘‘60- 
day period’’ the following: ‘‘or, at the option of the 
State, 1-year period’’; 
(3) in section 1902(l)(1)(A), by inserting after 
‘‘60-day period’’ the following: ‘‘, or, at the option of 
the State, 1-year period,’’; 
(4) in section 1903(v)(4)(A)(i), by inserting after 
‘‘60-day period’’ the following: ‘‘, or, at the option of 
the State, 1-year period,’’; and 
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(5) in section 1905(a), in the fourth sentence in 
the matter following paragraph (30), by inserting 
after ‘‘60-day period’’ the following: ‘‘, or, at the op-
tion of the State, 1-year period,’’. 
(b) STATE OPTION TO PROVIDE CONTINUOUS COV-
ERAGE FOR FULL BENEFITS FOR INDIVIDUALS WHO ARE 
OR BECOME PREGNANT.—Section 1902(e)(6) of the Social 
Security Act (42 U.S.C. 1396a(e)(6)), as amended by sub-
section (a), is further amended— 
(1) by striking ‘‘(6) In the case of a pregnant 
woman’’ and inserting 
‘‘(6)(A) In the case of a pregnant woman’’; and 
(2) by adding at the end the following: 
‘‘(B)(i) At the option of the State, the State plan may 
provide that an individual who is eligible for medical as-
sistance under the State plan (or a waiver of such plan) 
or for child health assistance under title XXI and who is, 
or who while so eligible becomes, pregnant shall continue 
to be eligible for such medical assistance or child health as-
sistance, respectively, through the end of the month in which 
the 1-year period (beginning on the last day of such preg-
nancy) ends, regardless of the basis for the individual’s eli-
gibility for such medical assistance.’’. 
(c) INCREASE OF FMAP.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
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(1) in subsection (b), in the first sentence, by 
striking ‘‘and (ff)’’ and inserting ‘‘(ff), and (gg)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) SPECIFIED COVERAGE EXTENSION STATES.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), beginning January 1, 2020, in the case of a spec-
ified coverage extension State, for the initial extension 
calendar quarters with respect to such State, the Fed-
eral medical assistance percentage that would other-
wise apply to the State without application of this 
subsection, shall be increased by 5 percentage points. 
‘‘(2) SPECIFIED COVERAGE EXTENSION STATE.— 
For purposes of this subsection, the term ‘specified 
coverage extension State’ means a State, the State 
plan of which has in effect the application of the 1– 
year period of continuous medical assistance pursu-
ant to each of paragraphs (5) and (6) of section 
1902(e). 
‘‘(3) INITIAL EXTENSION CALENDAR QUARTER.— 
For purposes of this subsection, the term ‘initial ex-
tension calendar quarter’ means, with respect to a 
State, each calendar quarter occurring in the first fis-
cal year that the State is a specified coverage exten-
sion State.’’. 
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(d) APPLICATION TO CHIP OPTIONAL COVERAGE OF 
TARGETED
LOW-INCOME
PREGNANT
WOMEN.—Section 
2112 of the Social Security Act (42 U.S.C. 1397ll) is 
amended— 
(1) in subsection (d)(2)(A), by inserting after 
‘‘60-day period’’ the following: ‘‘, or, at the option of 
the State, 1-year period’’; and 
(2) in subsection (f)(2), by inserting after ‘‘60- 
day period’’ the following: ‘‘, or, at the option of the 
State, 1-year period’’. 
(e) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to eligibility determinations 
for items and services under State plans under title XIX 
of the Social Security Act (or a waiver of such a plan) (42 
U.S.C. 1396 et seq.) and under State child health plans 
under title XXI (or waiver of such a plan) made on or after 
January 1, 2020. 
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 Pay-
ment and Access Commission (referred to in this section 
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 services 
under State Medicaid programs that currently pro-
vide coverage for such services, including the type of 
doula services offered (such as prenatal, labor and de-
livery, 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 in-
crease 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 en-
sure 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 con-
sult with relevant stakeholders, including— 
(1) States; 
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(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 com-
munities, including communities of color, and com-
munities 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 there-
after, 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 Secu-
rity Act (42 U.S.C. 1396 et seq.) and the Children’s Health 
Insurance Program under title XXI of such Act, of extend-
ing coverage to 365 days postpartum pursuant to the provi-
sions of (and amendments made by this Act). Such report 
shall include the information and recommendations de-
scribed 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 enactment 
of this Act, the Medicaid and CHIP Payment Advisory 
Commission shall submit to Congress a report containing 
an analysis of the use of bundled payments for reimbursing 
health care providers with respect to pregnancy-related 
services furnished under State plans (or waivers of such 
plans) under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.). 
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Union Calendar No. 428 
116TH CONGRESS 
2D SESSION 
H. R. 4996 
[Report No. 116–527] 
A BILL 
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 individuals, and for other 
purposes. 
SEPTEMBER 21, 2020 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
VerDate Sep 11 2014 
22:26 Sep 21, 2020
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