Maternity Care Coverage Expansion

Summary#

This bill (the MOMMIES Act) changes Medicaid and the Children’s Health Insurance Program (CHIP) rules to expand and improve care for low-income pregnant and postpartum people. The main changes are longer postpartum coverage, required full benefits (including dental), a maternity care home demonstration, higher minimum payment rates for primary care, and studies and guidance on doulas and telehealth. The broad goal is to improve maternal and infant health and reduce disparities.

Key changes:

• Postpartum coverage extended from 60 days to at least 1 year after the end of pregnancy for Medicaid and CHIP (states may choose a longer period).
• Full benefits required during that postpartum period (not just pregnancy-related services).
• Oral health coverage required for pregnant and postpartum individuals (preventive, diagnostic, periodontal, restorative).
• Maternity Care Home demonstration: federal grants to at least 10 states to fund coordinated, community‑based maternity care models for Medicaid/CHIP enrollees; national evaluator and 5‑year project.
• Reapplies a Medicare-based payment floor so certain Medicaid primary care services must be paid at least at specified Medicare rates and adds more provider types (including OB/GYNs, midwives, certain clinics).
• Maintenance-of-effort rules that limit states from cutting eligibility or benefits for these populations during specified periods.
• Federal support and studies: provides for a 100% federal match for additional costs tied to the bill’s requirements (as determined by the federal agency), requests GAO and MACPAC reports, and directs CMS guidance on doulas and telehealth.

What it means for you#

• Pregnant and postpartum people on Medicaid or CHIP

  • You would generally keep Medicaid/CHIP coverage for at least 1 year after pregnancy ends, instead of the current 60 days.
  • You would have access to the full range of benefits under the state plan during pregnancy and that 1‑year postpartum period, including covered dental care that meets specified professional recommendations.
  • You may be able to receive more coordinated, community‑based care if your state participates in the maternity care home demonstration.

• Parents and infants

  • The bill aims to improve prenatal and postpartum follow-up, increase postpartum visits (the demo sets a goal of at least five post‑pregnancy visits), and support services that affect newborn health.

• Health care providers (primary care, OB/GYN, midwives, dentists, doulas, community health workers)

  • Certain primary care services provided under Medicaid must be paid at or above specified Medicare-based rates for a set period, and more provider types are eligible for those rates.
  • States receiving demonstration grants may fund care coordinators, doulas, and community‑based staff and offer training and financial incentives.
  • MACPAC and CMS work could lead to more states covering doulas and clearer reimbursement practices.

• States and Medicaid agencies

  • States must maintain current eligibility and benefit levels for specified periods or risk losing some federal funds.
  • States may apply for demonstration grants and must enter into agreements with eligible local providers to run maternity care home models.
  • States will need to track outcomes, report, and comply with federal evaluation and documentation requirements.

• Managed care organizations

  • Contracts must ensure that payments to specified primary care providers meet the new minimums and must provide documentation to states and CMS to show compliance.

• Taxpayers

  • The bill directs the federal government to cover certain additional costs (see Expenses), and it authorizes federal appropriations for the demonstration project in future years.

Expenses#

No direct public cost estimate is identified in the available material.

• The bill creates a new 100% federal medical assistance percentage (FMAP) for additional state expenditures that are attributable to the bill’s Medicaid/CHIP requirements, for quarters starting January 1, 2027, as determined by the Secretary.
• It authorizes appropriations “such sums as may be necessary” for fiscal years 2027 through 2034 to run the maternity care home demonstration and to fund a national evaluator.
• States and managed care plans may face higher payment obligations (primary care payment floor and provider payment requirements) and administrative costs to implement, document, and report on new coverage and demonstration activities.
• Federal agencies (CMS, GAO, MACPAC) will produce reports and guidance; the bill does not provide specific budget figures for those activities.
• No publicly available information on total expected increases in federal or state spending, or on projected savings from reduced emergency visits or improved outcomes.

Proponents' View#

The bill appears intended to improve maternal and infant health, reduce disparities, and strengthen supports for low‑income mothers by:

• Extending coverage to 1 year postpartum to reduce gaps in care when many pregnancy‑related complications can appear.
• Requiring full benefits (including dental) during pregnancy and the postpartum period to address health needs that affect both maternal and infant outcomes.
• Encouraging coordinated, person‑centered care through maternity care homes that integrate medical, behavioral, oral health, and social services.
• Raising Medicaid payment rates for primary care to improve provider participation and access, and expanding which providers qualify.
• Studying and promoting doulas and telehealth as tools to increase access and culturally appropriate care.
• Targeting federal support (100% FMAP for certain costs) to help states implement these changes.

Opponents' View#

The bill’s design could raise several practical concerns based on its text:

• One concern is the lack of a publicly stated overall cost estimate; the bill authorizes federal funds and a 100% match for some costs, but it does not specify total spending levels or detailed budget offsets.
• It is unclear exactly which state expenditures will be counted as “attributable” to the bill for the 100% FMAP; the Secretary has discretion to determine this, which could create uncertainty for states.
• Reapplying higher Medicaid payment floors and expanding eligible providers may increase spending for Medicaid and managed care plans; states and plans may need time and funding to adapt payment systems.
• Implementation may be administratively complex: states must change eligibility procedures, add dental coverage, update managed care contracts, run demonstration projects, and collect and report outcome data.
• Workforce capacity is not guaranteed: expanding coverage and requiring services (dental care, doulas, midwives, care coordinators) may strain supply in areas with few providers unless parallel workforce development occurs.
• Some program timing provisions are complex (for example, different maintenance-of-effort periods for Medicaid and CHIP and the fact that many changes take effect January 1, 2027), which could be confusing for states and beneficiaries.