Summary#
This bill (the MOMMIES Act) would change Medicaid and CHIP rules to extend and expand coverage for pregnant and postpartum people, add oral health coverage, create a maternity care home grant program, and raise minimum Medicaid payment rates for primary care providers. The main goal is to improve maternal and infant health, reduce disparities, and increase access to coordinated care for low-income mothers.
- Main change: Postpartum coverage in Medicaid and CHIP would be extended from 60 days after pregnancy to at least 1 year (states may choose a longer period). Benefits during that time must be “full benefits” (the same scope as other full Medicaid benefits).
- Oral health: Medicaid would be required to cover a set of oral health services for pregnant and postpartum individuals, aligned with professional recommendations.
- Maternity care home demonstration: The bill creates a 5-year grant program to fund “maternity care home” models in at least 10 states, plus a national evaluator and state technical assistance.
- Provider payments: The bill re-applies a Medicare-based payment floor so Medicaid must pay primary care services at least 100% of the Medicare Part B rate for specified providers and extend that protection to additional provider types (including OB-GYNs, midwives, rural clinics, FQHCs, and advanced practice clinicians).
- Doula access and telehealth studies: The bill requires a MACPAC report on doula coverage, CMS guidance on expanding doula services under Medicaid, and a GAO report on Medicaid use of telehealth for maternity care.
- Federal support: For costs that are “additional amounts” caused by these amendments, the bill directs the federal share (FMAP) to be 100% for quarters starting January 1, 2027. The maternity care home grants are authorized “such sums as may be necessary” for fiscal years 2027–2034.
What it means for you#
- Pregnant and postpartum people on Medicaid or CHIP
- Coverage would continue for at least 1 year after the end of pregnancy instead of 60 days.
- During that year you would get full Medicaid benefits, including required oral health services.
- You may have access to new maternity care home programs in participating states that coordinate medical, social, and support services and aim for at least five postpartum visits.
- Low-income mothers and families
- The bill aims to increase access to care, care coordination, and support services (for example, housing help, transportation, mental health services, home visiting, breastfeeding support, and family planning).
- Health care providers
- Primary care, OB-GYNs, midwives, community health centers, rural clinics, and certain advanced practice clinicians would be included in a payment floor requiring higher Medicaid payment rates for primary care services.
- Managed care contracts would have to ensure payments meet the new minimums and provide documentation when requested.
- Doulas and community-based programs
- MACPAC must report on how states cover doulas and best practices. CMS must issue guidance to states on covering and paying doulas, including suggestions to support living wages for doulas.
- States and Medicaid agencies
- States would have to maintain current eligibility and benefit levels for low-income pregnant people through specified dates (a temporary “maintenance of effort” rule).
- States can apply for maternity care home grants and must enter arrangements with eligible entities to run the model.
- Managed care organizations
- Contracts must allow for the higher payment rates for primary care services and include documentation and approval procedures if payments are through capitation or value-based arrangements.
Expenses#
No direct public cost estimate is included in the bill text.
- The bill directs that the federal medical assistance percentage (FMAP, the federal share of Medicaid spending) be set at 100% for the additional expenditures that result from the bill’s new requirements, for quarters beginning January 1, 2027. The bill calls for the Secretary to determine which costs are “attributable” to the amendments.
- The maternity care home demonstration is authorized “such sums as may be necessary” for fiscal years 2027–2034. The bill does not list a dollar amount.
- The bill requires federal studies, reports, and CMS guidance (MACPAC, GAO, CMS), which will have administrative costs not specified in the bill.
- States may face administrative and operational costs to implement extended coverage, report outcomes, change provider payments, and run demonstration programs. The bill’s 100% FMAP provision covers additional amounts attributable to the requirements, but the text does not provide a comprehensive fiscal estimate or timeline of state versus federal costs.
Proponents' View#
The bill’s text lists goals and changes that suggest its intended benefits:
- The bill appears intended to reduce gaps in coverage after pregnancy by extending postpartum Medicaid/CHIP coverage to at least one year. This could improve follow-up care and treatment for postpartum conditions.
- It appears intended to improve maternal and infant health outcomes and reduce disparities by funding coordinated, culturally appropriate care and by including oral health and social supports in care models.
- Reapplying a Medicare-based payment floor for primary care services and expanding the list of covered provider types appears intended to strengthen primary and maternal care access, especially in rural and underserved areas.
- The maternity care home demonstration is designed to test team-based, community-centered care models that coordinate medical and social services and to identify whether those models improve outcomes and reduce unnecessary hospital use.
- Requiring reports and guidance (MACPAC, CMS, GAO) aims to identify barriers and effective practices for doulas and telehealth so states can expand access based on evidence.
Opponents' View#
The bill text leaves certain implementation and cost questions open, which could raise concerns:
- One concern is that the bill does not include a clear estimate of total federal or state costs. The 100% FMAP applies only to “additional amounts” attributable to the requirements, and the bill does not define how those amounts will be calculated in detail.
- It is unclear how payment rates will be set for items and services that do not have a Medicare Part B equivalent. The bill directs the Secretary to set some rates, which may create timing and administrative challenges.
- States may face short-term administrative burdens to change eligibility systems, enroll people, track outcomes, and modify managed care contracts.
- The maternity care home demo relies on grant funding authorized as “such sums as may be necessary,” without a stated budget amount, so the scale of the program is uncertain.
- The bill allows the Secretary to waive certain Medicaid requirements for the demonstration (statewideness, comparability). This could lead to variation in how models are applied across states and raise questions about equity or portability of benefits.
- Workforce capacity questions are not fully addressed in the bill text. Expanding services (for example, oral health, doulas, and home-based supports) may require more trained providers in some areas; the bill funds incentives and training but does not quantify whether that will be enough.