II 118th CONGRESS 1st Session S. 3509 IN THE SENATE OF THE UNITED STATES December 13, 2023 Mr. Brown (for himself, Mr. King , Ms. Baldwin , Mr. Casey , Ms. Smith , Mr. Blumenthal , Mr. Van Hollen , Mr. Merkley , Mr. Whitehouse , Ms. Cortez Masto , Mr. Kaine , Ms. Klobuchar , and Mr. Booker ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XXVII of the Public Health Service Act to provide for a special enrollment period for pregnant persons, and for other purposes.

1. Short title This Act may be cited as the Healthy Maternity and Obstetric Medicine Act or the Healthy MOM Act . 2. Providing for a special enrollment period for pregnant individuals (a) Special enrollment periods (1) Public Health Service Act Section 2702(b)(2) of the Public Health Service Act ( 42 U.S.C. 300gg–1(b)(2) ) is amended by inserting including a special enrollment period for pregnant individuals, beginning on the date on which the pregnancy is reported to the health insurance issuer before the period at the end. (2) Patient protection and affordable care act Section 1311(c)(6) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(c)(6) ) is amended— (A) in subparagraph (C), by striking and at the end; (B) by redesignating subparagraph (D) as subparagraph (E); and (C) by inserting after subparagraph (C) the following new subparagraph: (D) a special enrollment period for pregnant individuals, beginning on the date on which the pregnancy is reported to the Exchange; and . (3) Internal Revenue Code Section 9801(f) of the Internal Revenue Code of 1986 ( 26 U.S.C. 9801(f) ) is amended by adding at the end the following new paragraph: (4) For pregnant individuals (A) In general A group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan upon pregnancy, with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or the pregnancy is confirmed by a health care provider. (B) Regulations The Secretary shall promulgate regulations with respect to the special enrollment period under subparagraph (A), including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage. . (4) ERISA Section 701(f) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1181(f) ) is amended by adding at the end the following: (4) For pregnant individuals (A) In general A group health plan or health insurance issuer in connection with a group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms of the plan upon pregnancy, with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or health insurance issuer or the pregnancy is confirmed by a health care provider. (B) Regulations The Secretary shall promulgate regulations with respect to the special enrollment period under subparagraph (A), including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage. . (b) Effective date The amendments made by this section shall apply with respect to plan years beginning after December 31, 2024. 3. Coverage of maternity care for dependent children Section 2719A of the Public Health Service Act ( 42 U.S.C. 300gg–19a ) is amended— (1) in subsection (e), by inserting (other than subsection (f)) after this section ; and (2) by adding at the end the following: (f) Coverage of maternity care A group health plan, or health insurance issuer offering group or individual health insurance coverage, that provides coverage for dependants shall ensure that such plan or coverage includes coverage for maternity care associated with pregnancy, childbirth, and postpartum care for all participants, beneficiaries, or enrollees, including dependants, including coverage of labor and delivery. Such coverage shall be provided to all pregnant dependents regardless of age. . 4. Federal employee health benefit plans (a) Coverage of pregnancy The Director of the Office of Personnel Management shall issue such regulations as are necessary to ensure that pregnancy is considered a change in family status and a qualifying life event for an individual who is eligible to enroll, but is not enrolled, in a health benefit plan under chapter 89 of title 5, United States Code. (b) Effective date The requirement in subsection (a) shall apply with respect to any contract entered into under section 8902 of such title beginning 12 months after the date of enactment of this Act. 5. Continuation of Medicaid income eligibility standard for pregnant individuals and infants Section 1902(l)(2)(A) of the Social Security Act ( 42 U.S.C. 1396a(l)(2)(A) ) is amended— (1) in clause (i), by striking and not more than 185 percent ; (2) in clause (ii)— (A) in subclause (I), by striking and after the comma; (B) in subclause (II), by striking the period at the end and inserting , and ; and (C) by adding at the end the following: (III) January 1, 2025, is the percentage provided under clause (v). ; and (3) by adding at the end the following new clause: (v) The percentage provided under clause (ii) for medical assistance provided on or after January 1, 2025, with respect to individuals described in subparagraph (A) or (B) of paragraph (1) shall not be less than— (I) the percentage specified for such individuals by the State in an amendment to its State plan (whether approved or not) as of January 1, 2014; or (II) if no such percentage is specified as of January 1, 2014, the percentage established for such individuals under the State's authorizing legislation or provided for under the State's appropriations as of that date. . 6. Requiring 12-month continuous coverage for pregnant and postpartum individuals under Medicaid and CHIP (a) Medicaid Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— (1) in subsection (a)— (A) in paragraph (86), by striking and at the end; (B) in paragraph (87), by striking the period at the end and inserting ; and ; and (C) by inserting after paragraph (87) the following new paragraph: (88) provide that the State plan is in compliance with subsection (e)(16). ; and (2) in subsection (e)(16)— (A) in subparagraph (A), by striking 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 ; (B) in subparagraph (B), in the matter preceding clause (i), by striking by a State making an election under this paragraph and inserting under a State plan (or a waiver of such State plan) ; and (C) by striking subparagraph (C). (b) CHIP (1) In general Section 2107(e)(1)(J) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1)(J) ) 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 pregnancy and throughout the 12-month postpartum period under title XIX). . (2) Conforming Section 2112(d)(2)(A) of the Social Security Act ( 42 U.S.C. 1397ll(d)(2)(A) ) is amended by striking the month in which the 60-day period and all that follows through the period and inserting the 12-month period beginning on the last day of the pregnancy. . (c) Effective date (1) In general Subject to paragraph (2), the amendments made by this section shall take effect on the first day of the first calendar quarter that begins on or after the date that is 1 year after the date of enactment of this Act. (2) Exception for State legislation In the case of a State plan under title XIX or XXI of the Social Security 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 section, the 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 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. 7. Relationship to other laws Nothing in this Act (or an amendment made by this Act) shall be construed to invalidate or limit the remedies, rights, and procedures of any Federal law or the law of any State or political subdivision of any State or jurisdiction that provides greater or equal protection for enrollees in a group health plan or group or individual health insurance offered by a health insurance issuer.