Mamas First Act
Bill: S.4100 | Sponsor: Sen. Warren, Elizabeth (D-MA)
Policy area: Health

Summary:
Mamas First Act
This bill requires state Medicaid programs to cover doula and midwife services, including prenatal, delivery, and postpartum services, in a variety of settings.

To amend title XIX of the Social Security Act to provide coverage under 
the Medicaid program for services provided by doulas and midwives, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Mamas First Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the Centers for Disease Control and 
        Prevention, the maternal mortality rate varies drastically for 
        women by race and ethnicity. On 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 disparately impacts African-American women 
        and indigenous women, this urgent public health crisis 
        traverses race, ethnicity, socioeconomic status, educational 
        background, and geography.
            (2) United States maternal mortality rates are the highest 
        in the developed world and are increasing 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 likely to initiate breastfeeding.
            (5) Midwife-led care is associated with cost savings, 
        decreased rates of intervention, lower cesarean rates, lower 
        preterm birth rates, and healthier outcomes for mothers and 
        babies.
            (6) Midwives may practice in any setting, including the 
        home, community, hospitals, birth centers, clinics, or health 
        units.

SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY DOULAS AND MIDWIVES.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (30), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (31) as paragraph 
                (32); and
                    (C) by inserting after paragraph (30) the following 
                new paragraph:
            ``(31) services and care, including prenatal, delivery, and 
        postpartum care, that is provided in a culturally congruent 
        manner (as defined in subsection (kk)) by doulas, midwives, and 
        tribal midwives (as those terms are defined in subsection 
        (jj)), that is provided in the home, community, a hospital, 
        birth center, clinic, health unit, or is furnished via 
        telehealth to the extent authorized under State law; and''; and
            (2) by adding at the end the following:
    ``(jj) Doulas, Midwives, and Tribal Midwife Defined.--For purposes 
of subsection (a)(31):
            ``(1) Doulas defined.--The term `doula' means an individual 
        who--
                    ``(A) has completed 60 hours of foundational 
                training;
                    ``(B) 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 provide non-medical 
                advice, information, emotional support, and physical 
                comfort to an individual during such individual's 
                pregnancy, childbirth, and postpartum period; and
                    ``(C) maintains such certification by completing 
                such required continuing education.
            ``(2) Midwives defined.--The term `midwife' means a midwife 
        who meets at a minimum the international definition of the 
        midwife and global standards for midwifery education as 
        established by the International Confederation of Midwives.
            ``(3) Tribal midwife defined.--The term `tribal midwife' 
        means an individual who is recognized by an Indian tribe (as 
        defined in section 4 of the Indian Health Care Improvement Act 
        (25 U.S.C. 1603)) to practice midwifery for such tribe.
    ``(kk) Culturally Congruent Care Defined.--For purposes of 
subsection (a)(31), the term `culturally congruent care', with respect 
to maternity care, means care that is provided in agreement with the 
preferred cultural values, beliefs, worldview, language, and practices 
of the health care consumer and other stakeholders.''.
    (b) Requiring Mandatory Coverage Under State Plan.--Section 
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) 
is amended, in the matter preceding clause (i), by striking ``and 
(30)'' and inserting ``(30), and (31)''.
    (c) Conforming Amendments.--
            (1) Section 1902(nn)(3) of the Social Security Act (42 
        U.S.C. 1396a(nn)(3)) is amended by striking ``(30)'' and 
        inserting ``(32)''.
            (2) Section 1905(a) of the Social Security Act (42 U.S.C. 
        1396d(a)) is amended, in the 5th sentence, by striking ``(30)'' 
        and inserting ``(32)''.
    (d) 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, 2022.
            (2) Exception for state legislation.--In the case of a 
        State plan under title XIX of the Social 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 amendments 
        made by this section, the respective plan shall not be regarded 
        as failing to comply with the requirements of such title solely 
        on the basis of its failure to meet such an additional 
        requirement before 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 the 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 separate regular 
        session of the State legislature.
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