,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #bggh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjai ,mrs4 
,watson ,coleman 7= h]self1 ,ms4 ,adams1
 ,ms4 ,b>ragn1 ,ms4 ,bonamici1 ,ms4     
,cl>k ( ,massa*usetts1 ,ms4 ,cl>ke (    
,new ,york1 ,mr4 ,coh51 ,mr4 ,connolly1 
,ms4 ,del,bene1 ,mrs4 ,d+ell1 ,mr4      
,mi*ael ,f4 ,doyle ( ,p5nsylvania1 ,mr4 
,engel1 ,mr4 ,espaillat1 ,mr4 ,fo/]1    
,ms4 ,frankel1 ,mr4 ,gallego1 ,mr4      
,grijalva1 ,ms4 ,haal&1 ,mr4 ,ha/+s1    
,ms4 ,jackson ,lee1 ,ms4 ,kelly (       
,ill9ois1 ,mr4 ,khanna1 ,mrs4           
,kirkpatrick1 ,mr4 ,langev91 ,mrs4      
,lawr5ce1 ,ms4 ,lee ( ,cali=nia1 ,mr4   
,lewis1 ,ms4 ,mc,collum1 ,ms4 ,m5g1 ,mr4
 ,sean ,patrick ,maloney ( ,new ,york1  
,ms4 ,moore1 ,mr4 ,m\lton1 ,mr4 ,nadl]1 
,ms4 ,norton1 ,mr4 ,pascrell1 ,mr4      
,rask91 ,ms4 ,roybal-,all>d1 ,mr4 ,ryan1
 ,mr4 ,s*iff1 ,mr4 ,tonko1 ,mr4 ,trone1 
,ms4 ,wilson ( ,florida1 ,ms4 ,wass]man 
,s*ultz1 ,ms4 ,velzquez1 ,mrs4 ,beatty1 
,mr4 ,veasey1 ,mr4 ,v>gas1 ,mr4 ,br[n ( 

,m>yl&1 ,ms4 ,bass1 ,mr4 ,?ompson (     
,mississippi1 & ,mr4 ,ri*mond7 introduc$
 ! foll[+ bill2 :i* 0 ref]r$ to !       
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means1 ,ov]sight & ,re=m1 & ,education 
& ,labor1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xxvii ( !     
,public ,heal? ,s]vice ,act to provide =
 a special enrollm5t p]iod = pregnant   
wom51 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,heal?y      
,mat]nity & ,ob/etric ,m$ic9e ,act or ! 
,heal?y ,,mom ,act4  #b4 ,f9d+s &       
purpose  7a7 ,f9d+s ,congress f9ds !    
foll[+3  7#a7 ,pregnancy is a           
significant life ev5t = millions ( wom5 
9 ! ,unit$ ,/ates ea* ye>4  7#b7 ,= m   
?an #cj ye>s1 our ,nation1 ?r\gh !      
,m$icaid program1 has recogniz$ t       
pregnant wom5 ne$ imm$iate access to    
af=dable c>e1 & has all[$ wom5 :o meet  

income-eligibility requirem5ts to enroll
 9 ,m$icaid cov]age :5 !y become        
pregnant4  7#c7 ,congress recogniz$ !   
c5tral importance ( mat]nity cov]age by 
classify+ mat]nity & newborn c>e z "o ( 
! t5 ess5tial heal? b5efits t mu/ n[ be 
cov]$ on mo/ individual & small gr\p    
heal? insurance plans "u section        
#acjb7;b77#a7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjbb7;b77#a774  7#d7 ,congress has    
also recogniz$ ! significant *all5ge (  
mat]nal mortality & ! ne$ to elim9ate   
disp>ities 9 mat]nal heal? outcomes =   
pregnancy-relat$ & pregnancy-associat$  
dea?s1 & to improve heal? outcomes = bo?
 mo!rs & babies ?r\gh passage ( !       
,prev5t+ ,mat]nal ,dea?s ,act ( #bjah   
7,public ,law #aae-cdd74  7#e7 ,access  
to compreh5sive mat]nity cov]age all[s  
wom5 to access important                
pregnancy-relat$ c>e1 :i* is demon/rat$ 
to improve heal? outcomes = wom5 &      
newborns & r$uce f9ancial co/s = bo?    
consum]s & insur]s4  7#f7 ,un9sur$ wom51

 wom5 ) gr&fa!r$ & transitional heal?   
plans1 self-fund$ /ud5t heal? plans1 &  
cata/rophic & high-d$uctible heal? plans
 may lack access to compreh5sive &      
af=dable mat]nity cov]age4  7#g7        
,employ] heal? plans t exclude dep5d5t  
daught]s f mat]nity cov]age leave "y    
wom5 )\t cov]age = _! pregnancy1 ev5    
?\gh ,f$]al law has long held t treat+  
pregnancy diff]5tly ?an o!r conditions  
is sex-bas$ discrim9ation4  7#h7 ,a     
special enrollm5t p]iod is especially   
important = "y adults1 :o are at high   
risk = un9t5d$ pregnancies1 yet "y      
adults are frequ5tly enroll$ 9          
cata/rophic cov]age1 :i* (t5 has few]   
b5efits1 m re/rictions1 & high]         
d$uctibles4  7#i7 ,?is cov]age w\ld be  
an equaliz] = communities ( color4 ,!   
mat]nal mortality rate v>ies dra/ically 
by race & e?nicity1 & :]e a woman lives4
 ,! ris+ mat]nal mortality rate 9 !     
,unit$ ,/ates is driv5 pr$om9antly by ! 
disproportionately high                 
,african-,am]ican mat]nal mortality     

rate1 :i* is f\r times m ?an ! rate =   
,:ite wom54  7#aj7 ,accord+ to ! ,c5t]s 
= ,disease ,control & ,prev5tion1 ab\t  
#gjj wom5 die ea* ye> 9 ! ,unit$ ,/ates 
f pregnancy-relat$ complications4 ,black
 & ,am]ican ,indian_/,alaska ,native    
wom5 are ab\t ?ree times m likely to die
 f a pregnancy-relat$ cause ?an ,:ite   
wom54  7#aa7 ,data demon/rates t #c 9 #e
 pregnancy relat$ dea?s c\ld be prev5t$4
 ,improv+ access to c>e is "o way to    
help prev5t dea?s1 reg>dless ( race or  
e?nicity4  7#ab7 ,timely mat]nity c>e   
improves ! heal? ( pregnant wom51 z well
 z bir? outcomes & ! heal? ( babies     
?r\gh\t _! lifetimes4 ,pregnancy-relat$ 
mat]nal mortality is ?ree to f\r times  
high] among wom5 :o receive no mat]nity 
c>e comp>$ to wom5 :o d4 ,regul>        
mat]nity c>e c detect or mitigate s]i\s 
pregnancy-relat$ heal? complications1   
includ+ preeclampsia1 plac5tal          
abruption1 complications f diabetes1    
complications f he>t disease1 & ,graves'
 disease1 all ( :i* c result 9 morbidity

 or mortality = ! "m or newborn4  7#ac7 
,! ,c5t]s = ,disease ,control &         
,prev5tion reports t m ?an half ( all   
mat]nal dea?s occur at deliv]y or 9 !   
fir/ po/p>tum ye>1 :]eas j m ?an "o-?ird
 ( pregnancy-relat$ or                  
pregnancy-associat$ dea?s occur :ile a  
p]son is /ill pregnant4 ,yet1 = wom5    
eligible = ! ,m$icaid program on ! basis
 ( pregnancy1 su* ,m$icaid cov]age      
lapses at ! end ( ! mon? on :i* ! #fj?  
po/p>tum day l&s4  7#ad7 ,timely        
mat]nity c>e & adequate po/p>tum c>e c  
r$uce %ort- & long-t]m heal? c>e co/s4  
,if a woman does n h access to af=dable 
mat]nity c>e dur+ h] pregnancy1 & %e or 
h] newborn exp]i5ces pregnancy          
complications t result 9 heal? problems 
aft] bir?1 _! insur] may end up pay+ mu*
 high] co/s ?an if ! insur] _h cov]$ !  
woman's mat]nity c>e dur+ h] pregnancy4 
,int5sive mat]nity c>e c r$uce hospital 
& neonatal int5sive c>e unit admissions 
among infants1 result+ 9 co/ sav+s (    
#a1gfh to #e1efj p] bir?4 ,= wom5 )     

high-risk pregnancies1 int5sive mat]nity
 c>e saves #a4cg = e #a inve/$ 9        
mat]nity c>e4  7b7 ,purpose ,! purpose (
 ?is ,act is to protect ! heal? ( wom5 &
 newborns by ensur+ t all wom5 eligible 
= cov]age ?r\gh ! ,ex*anges e/abli%$ "u 
title ,i ( ! ,pati5t ,protection &      
,af=dable ,c>e ,act 7,public ,law       
#aaa-adh7 & wom5 eligible = o!r         
individual or gr\p heal? plan cov]age c 
access af=dable heal? cov]age dur+ _!   
pregnancy4  #c4 ,provid+ = a special    
enrollm5t p]iod = pregnant individuals  
7a7 ,public ,heal? ,s]vice ,act ,section
 #bgjb7;b77#b7 ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#a7;b77#b77 is am5d$ by ins]t+  
includ+ a special enrollm5t p]iod =     
pregnant individuals1 beg9n+ on ! date  
on :i* ! pregnancy is report$ to ! heal?
 insurance issu] be=e ! p]iod at ! end4 
7b7 ,pati5t protection & af=dable c>e   
act ,section #acaa7;c77#f7 ( ! ,pati5t  
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;c77#f77 is am5d$--    

7#a7 9 subp>agraph 7,c71 by /rik+ & at !
 end2  7#b7 by r$esignat+ subp>agraph   
7,d7 z subp>agraph 7,e72 &  7#c7 by     
ins]t+ aft] subp>agraph 7,c7 ! foll[+   
new subp>agraph3  7,d7 a special        
enrollm5t p]iod = pregnant individuals1 
beg9n+ on ! date on :i* ! pregnancy is  
report$ to ! ,ex*ange2 &  4  7c7        
,special enrollm5t p]iods  7#a7 ,int]nal
 ,rev5ue ,code ,section #ihja7;f7 ( !   
,int]nal ,rev5ue ,code ( #aihf 7#bf     
,u4,s4,c4 #ihja7;f77 is am5d$ by add+ at
 ! end ! foll[+ new p>agraph3  7#d7 ,=  
pregnant individuals  7,a7 ,a gr\p heal?
 plan %all p]mit an employee :o is      
eligible1 b n enroll$1 = cov]age "u !   
t]ms ( ! plan 7or a dep5d5t ( su* an    
employee if ! dep5d5t is eligible1 b n  
enroll$1 = cov]age "u su* t]ms7 to      
enroll = cov]age "u ! t]ms ( ! plan ^u  
pregnancy1 ) ! special enrollm5t p]iod  
beg9n+ on ! date on :i* ! pregnancy is  
report$ to ! gr\p heal? plan or !       
pregnancy is confirm$ by a heal? c>e    
provid]4  7,b7 ,! ,secret>y %all        

promulgate regulations ) respect to !   
special enrollm5t p]iod "u subp>agraph  
7,a71 includ+ e/abli%+ a "t p]iod =     
pregnant individuals to enroll 9 cov]age
 & effective date ( su* cov]age4  4     
7#b7 ,,erisa ,section #gja7;f7 ( !      
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aaha7;f77  
is am5d$ by add+ at ! end ! foll[+3     
7#d7 ,= pregnant individuals  7,a7 ,a   
gr\p heal? plan or heal? insurance issu]
 9 connection ) a gr\p heal? plan %all  
p]mit an employee :o is eligible1 b n   
enroll$1 = cov]age "u ! t]ms ( ! plan   
7or a dep5d5t ( su* an employee if !    
dep5d5t is eligible1 b n enroll$1 =     
cov]age "u su* t]ms7 to enroll = cov]age
 "u ! t]ms ( ! plan ^u pregnancy1 ) !   
special enrollm5t p]iod beg9n+ on ! date
 on :i* ! pregnancy is report$ to ! gr\p
 heal? plan or heal? insurance issu] or 
! pregnancy is confirm$ by a heal? c>e  
provid]4  7,b7 ,! ,secret>y %all        
promulgate regulations ) respect to !   
special enrollm5t p]iod "u subp>agraph  

7,a71 includ+ e/abli%+ a "t p]iod =     
pregnant individuals to enroll 9 cov]age
 & effective date ( su* cov]age4  4  7d7
 ,effective date ,! am5dm5ts made by ?is
 section %all apply ) respect to plan   
ye>s beg9n+ aft] ! #bjai plan ye>4  #d4 
,cov]age ( mat]nity c>e = dep5d5t *ildr5
 ,section #bgai;,a ( ! ,public ,heal?   
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ai;a7 is am5d$ by add+ at ! end
 ! foll[+3  7e7 ,cov]age ( mat]nity c>e 
,a gr\p heal? plan1 or heal? insurance  
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 t provides cov]age = 
dep5dants %all ensure t su* plan or     
cov]age includes cov]age = mat]nity c>e 
associat$ ) pregnancy1 *ildbir?1 &      
po/p>tum c>e = all p>ticipants1         
b5efici>ies1 or enrollees1 includ+      
dep5dants1 includ+ cov]age ( labor &    
deliv]y4 ,su* cov]age %all be provid$ to
 all pregnant dep5d5ts reg>dless ( age4 
4  #e4 ,f$]al employee heal? b5efit     
plans  7a7 ,cov]age ( pregnancy  7#a7 ,9
 g5]al ,! ,director ( ! ,(fice (        

,p]sonnel ,managem5t %all issue su*     
regulations z are necess>y to ensure t  
pregnancy is consid]$ a *ange 9 family  
/atus & a qualify+ life ev5t = an       
individual :o is eligible to enroll1 b  
is n enroll$1 9 a heal? b5efit plan "u  
*apt] #hi title #e1 ,unit$ ,/ates ,code4
  7#b7 ,effective date ,! requirem5t 9  
p>agraph 7#a7 %all apply ) respect to   
any contract ent]$ into "u section #hijb
 ( su* title beg9n+ #ab mon?s aft] !    
date ( enactm5t ( ?is ,act4  7b7        
,designat+ c]ta9 ,,fehbp-,relat$ s]vices
 z except$ s]vices "u ! ,anti-,defici5cy
 ,act  7#a7 ,9 g5]al ,section #hije (   
title #e1 ,unit$ ,/ates ,code1 is am5d$ 
by add+ at ! end ! foll[+3  7i7 ,any    
s]vices by an (fic] or employee "u ?is  
*apt] relat+ to enroll+ individuals 9 a 
heal? b5efits plan "u ?is *apt]1 or     
*ang+ ! enrollm5t ( an individual       
already s enroll$ due to an ev5t        
describ$ 9 section #e7;a77#a7 ( !       
,heal?y ,,mom ,act1 %all be deem$1 =    
purposes ( section #acdb ( title #ca1   

s]vices = em]g5cies involv+ ! safety (  
human life or ! protection ( prop]ty4  4
  7#b7 ,application ,! am5dm5t made by  
p>agraph 7#a7 %all apply to any lapse 9 
appropriations beg9n+ on or aft] ! date 
( enactm5t ( ?is ,act4  #f4 ,cont9uation
 ( ,m$icaid income eligibility /&>d =   
pregnant individuals & infants ,section 
#aijb7l77#b77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;a7l77#b77;,a77
 is am5d$--  7#a7 9 clause 7i71 by /rik+
 & n m ?an #ahe p]c5t2  7#b7 9 clause   
7ii7--  7,a7 9 subclause 7,i71 by /rik+ 
& aft] ! comma2  7,b7 9 subclause       
7,,ii71 by /rik+ ! p]iod at ! end &     
ins]t+ 1 &2 &  7,c7 by add+ at ! end !  
foll[+3  7,,iii7 ,janu>y #a1 #bjbj1 is !
 p]c5tage provid$ "u clause 7v74  2 &   
7#c7 by add+ at ! end ! foll[+ new      
clause3  7v7 ,! p]c5tage provid$ "u     
clause 7ii7 = m$ical assi/ance provid$  
on or aft] ,janu>y #a1 #bjbj1 ) respect 
to individuals describ$ 9 subp>agraph   
7,a7 or 7,b7 ( p>agraph 7#a7 %all n be  
less ?an--  7,i7 ! p]c5tage specifi$ =  

su* individuals by ! ,/ate 9 an am5dm5t 
to its ,/ate plan 7:e!r approv$ or n7 z 
( ,janu>y #a1 #bjad2 or  7,,ii7 if no   
su* p]c5tage is specifi$ z ( ,janu>y #a1
 #bjad1 ! p]c5tage e/abli%$ = su*       
individuals "u ! ,/ate's au?oriz+       
legislation or provid$ = "u ! ,/ate's   
appropriations z ( t date4  4  #g4      
#ab-mon? cont9u\s cov]age = pregnant &  
po/p>tum individuals "u ,m$icaid & ,,*ip
  7a7 ,m$icaid  7#a7 ,requir$ = all     
eligibility pa?ways ,p>agraph 7#e7 (    
section #aijb7;e7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acif;a7e77 is am5d$
 to read z foll[s3  7#e7 ,any individual
 :o is eligible = m$ical assi/ance "u ! 
,/ate plan or a waiv] ( su* plan & :o   
is1 or :o :ile s eligible becomes1      
pregnant %all cont9ue to be eligible "u 
! plan or waiv] = m$ical assi/ance t    
provides at lea/ ess5tial heal? b5efits 
z describ$ 9 section #acjb7;b7 ( !      
,pati5t ,protection & ,af=dable ,c>e    
,act1 ?r\gh ! end ( ! mon? 9 :i* !      
#a-ye> p]iod 7beg9n+ on ! la/ day ( h]  

pregnancy7 ends1 reg>dless ( ! basis = !
 individual's eligibility = m$ical      
assi/ance1 includ+ if ! individual's    
eligibility = m$ical assi/ance is on !  
basis ( be+ pregnant4  4  7#b7 ,con=m+  
am5dm5ts ,title ,,xix ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$-- 7,a7 9 section #aijb-- 
7i7 9 subsection 7a77#aj71 9 ! matt]    
foll[+ subp>agraph 7,g7 by /rik+ 7,,vii7
 ! m$ical assi/ance & all t foll[s ?r\gh
 complicate pregnancy12  7ii7 9         
subsection 7e77#f71 by /rik+ #fj-;day & 
ins]t+ #a-ye>2 &  7iii7 9 subsection    
7l77#a77;,a71 by /rik+ #fj-;day & ins]t+
 #a-ye>2  7,b7 9 section                
#aijc7v77#d77;,a77i71 by /rik+ #fj-;day 
& ins]t+ #a-ye>2 &  7,c7 9 section      
#aije7;a71 9 ! #d? s5t5ce 9 ! matt]     
foll[+ p>agraph 7#cj71 by /rik+ #fj-;day
 & ins]t+ #a-ye>4  7b7 ,,*ip  7#a7 ,9   
g5]al ,section #bajg7;e77#a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acig;gg7e77#a77 is am5d$--  7,a7 by    
r$esignat+ subp>agraphs 7,h7 ?r\gh 7,s7 

z subp>agraphs 7,i7 ?r\gh 7,t71         
respectively2 &  7,b7 by ins]t+ aft]    
subp>agraph 7,g71 ! foll[+3  7,h7       
,section #aijb7;e77#e7 7requir+ #ab-mon?
 cont9u\s cov]age = pregnant            
individuals74  4  7#b7 ,con=m+ am5dm5ts 
,subsections 7d77#b77;,a7 & 7f77#b7 (   
section #baab ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acigll7 are ea* am5d$  
by /rik+ #fj-;day & ins]t+ #a-ye>4  7c7 
,effective date  7#a7 ,9 g5]al ,subject 
to p>agraph 7#b71 ! am5dm5ts made by ?is
 section %all take effect on ! #a/ day (
 ! #a/ cal5d> qu>t] t beg9s on or aft] !
 date t is #a ye> aft] ! date ( enactm5t
 ( ?is ,act4  7#b7 ,exception = ,/ate   
legislation ,9 ! case ( a ,/ate plan "u 
title ,,xix ( ! ,social ,security ,act  
or a ,/ate *ild heal? plan "u title     
,,xxi ( su* ,act t ! ,secret>y ( ,heal? 
& ,human ,s]vices det]m9es requires     
,/ate legislation 9 ord] = ! respective 
plan to meet any requirem5t impos$ by   
am5dm5ts made by ?is section1 !         
respective plan %all n be reg>d$ z fail+

 to comply ) ! requirem5ts ( su* title  
solely on ! basis ( its failure to meet 
su* an additional requirem5t be=e ! fir/
 day ( ! fir/ cal5d> qu>t] beg9n+ aft] !
 close ( ! fir/ regul> session ( ! ,/ate
 legislature t beg9s aft] ! date (      
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4  #h4 ,relation%ip to o!r   
laws ,no?+ 9 ?is ,act 7or an am5dm5t    
made by ?is ,act7 %all be con/ru$ to    
invalidate or limit ! rem$ies1 rights1 &
 proc$ures ( any ,f$]al law or ! law (  
any ,/ate or political subdivision ( any
 ,/ate or jurisdiction t provides great]
 or equal protection = enrollees 9 a    
gr\p heal? plan or gr\p or individual   
heal? insurance (f]$ by a heal?         
insurance issu]4