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Medicaid Guidance for Postpartum Pelvic Health

Full Title:
Optimizing Postpartum Outcomes Act of 2025

Summary#

The bill directs the Department of Health and Human Services to issue guidance to States on Medicaid and CHIP coverage of certain pelvic health services during the prenatal and postpartum period. It also directs the Government Accountability Office to study coverage gaps, and it requires a CDC-led education and training program for health professionals and postpartum women about pelvic floor exams and pelvic health physical therapy. The bill defines what counts as the postpartum period and what services are “covered pelvic health services,” and it authorizes limited funding for the education campaign.

  • Main change: HHS must issue guidance to States on covering pelvic floor exams and pelvic health physical therapy in Medicaid and CHIP within one year.
  • Study: GAO must report to Congress within one year on gaps in Medicaid coverage for postpartum women.
  • Education program: CDC will run a pelvic health education and training program for providers and postpartum women.
  • Definitions: The postpartum period is defined as the longer of lactation or six months after pregnancy; pelvic floor exam and pelvic health physical therapy are defined in the bill.
  • Funding: $2,000,000 is authorized per year for fiscal years 2026–2030 to run the education campaign.

What it means for you#

  • Postpartum women and pregnant people: This could mean more information and outreach about pelvic floor exams and pelvic health physical therapy. It may lead to more screening and referrals if States follow the guidance. The bill itself does not automatically expand Medicaid or CHIP benefits for individuals; States would still make coverage decisions unless they change their plans.
  • Medicaid and CHIP enrollees: If your State acts on the guidance, you may see clearer coverage policies or new payment models for pelvic health services. If your State does not act, your coverage may not change.
  • Health care providers (OB/GYNs, midwives, physical therapists): There may be new training materials and suggested clinical codes to help identify pelvic floor conditions. Providers might see more referrals for pelvic health physical therapy.
  • State Medicaid agencies: States will get HHS recommendations on financing options, payment models, coding, and incentives to expand screening, referral, and access. The guidance is not a federal mandate; States can choose whether and how to adopt it.
  • Health systems and clinics: If States and payers adopt changes, clinics may need to adjust billing codes, referral pathways, and staffing to provide pelvic health physical therapy and examinations.

Expenses#

Estimated public cost: The bill authorizes $2,000,000 per year for the education campaign for fiscal years 2026–2030.

  • $2,000,000 per year is authorized to the CDC for the pelvic health education and training program (total authorized over five years: $10,000,000).
  • No fiscal estimate is provided in the bill text for costs to HHS to develop guidance, for the GAO study, or any additional Medicaid spending if States expand coverage.
  • No specific funding is provided to States to change Medicaid or CHIP coverage; any increased Medicaid spending would depend on State decisions.
  • No publicly available information on other administrative or implementation costs in the material supplied.

Proponents' View#

  • The bill appears intended to increase attention to postpartum pelvic health by encouraging States and providers to screen for pelvic floor problems and to provide or cover pelvic health physical therapy.
  • Supporters may see the guidance and recommended codes as a way to make it easier for States to track and pay for pelvic health services.
  • The CDC education program is designed to improve provider knowledge and patient awareness about what pelvic floor exams involve and how pelvic health physical therapy can help.
  • The GAO study is meant to identify concrete gaps in Medicaid coverage for postpartum women so Congress and States can consider policy changes.

Opponents' View#

  • One concern is that the HHS product is guidance, not a requirement; it does not force States to change Medicaid or CHIP coverage, so practical change is uncertain.
  • The bill does not provide funds to States to expand coverage. Any increase in Medicaid spending would be decided and funded by States, so low-income women in some States might not gain new benefits.
  • The authorized $2,000,000 per year for education is modest; it may be too small to drive large nationwide changes in provider training or public awareness.
  • The bill does not clearly explain how patient consent, privacy, or safeguards for internal pelvic exams would be handled in the education or implementation materials.
  • The bill may raise implementation questions: suggested coding and expanded screening could increase demand for pelvic health therapists, but the bill does not address workforce capacity or reimbursement rates.