,,ii  #aafth ,,congress  #ast ,session  
,s4 #adha  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #ae1      
#bjai,mr4 ,brown 7for himself1 ,ms4     
,smith1 ,mrs4 ,gillibrand1 ,mr4 ,markey1
 ,ms4 ,klobuchar1 ,mr4 ,tester1 ,ms4    
,hassan1 ,mr4 ,blumenthal1 ,ms4 ,harris1
 ,mr4 ,casey1 ,mr4 ,whitehouse1 ,mr4    
,booker1 ,mr4 ,merkley1 ,mr4 ,peters1   
,mr4 ,king1 ,ms4 ,rosen1 ,mr4 ,leahy1   
,ms4 ,cortez ,masto1 ,ms4 ,baldwin1 ,mr4
 ,jones1 and ,mr4 ,kaine7 introduced the
 following bill2 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 women1 and for     
other purposes4  #a4 ,short title ,this 
,act may be cited as the ,healthy       
,maternity and ,obstetric ,medicine ,act
 or the ,healthy ,,mom ,act4  #b4       
,findings and purpose  7a7 ,findings    
,congress finds the following3 7#a7     
,pregnancy is a significant life event  

for millions of women in the ,united    
,states each year4  7#b7 ,for more than 
#cj years1 our ,nation1 through the     
,medicaid program1 has recognized that  
pregnant women need immediate access to 
affordable care1 and has allowed women  
who meet income-eligibility requirements
 to enroll in ,medicaid coverage when   
they become pregnant4  7#c7 ,congress   
recognized the central importance of    
maternity coverage by classifying       
maternity and newborn care as one of the
 ten essential health benefits that must
 now be covered on most individual and  
small group health insurance plans under
 section #acjb7;b77#a7 of the ,patient  
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjbb7;b77#a774  7#d7   
,congress has also recognized the       
significant challenge of maternal       
mortality and the need to eliminate     
disparities in maternal health outcomes 
for pregnancy-related and               
pregnancy-associated deaths1 and to     
improve health outcomes for both mothers

 and babies through passage of the      
,preventing ,maternal ,deaths ,act of   
#bjah 7,public ,law #aae-cdd74  7#e7    
,access to comprehensive maternity      
coverage allows women to access         
important pregnancy-related care1 which 
is demonstrated to improve health       
outcomes for women and newborns and     
reduce financial costs for both         
consumers and insurers4  7#f7 ,uninsured
 women1 women with grandfathered and    
transitional health plans1 self-funded  
student health plans1 and catastrophic  
and high-deductible health plans may    
lack access to comprehensive and        
affordable maternity coverage4  7#g7    
,employer health plans that exclude     
dependent daughters from maternity      
coverage leave young women without      
coverage for their pregnancy1 even      
though ,federal law has long held that  
treating pregnancy differently than     
other conditions is sex-based           
discrimination4  7#h7 ,a special        
enrollment period is especially         

important for young adults1 who are at  
high risk for unintended pregnancies1   
yet young adults are frequently enrolled
 in catastrophic coverage1 which often  
has fewer benefits1 more restrictions1  
and higher deductibles4  7#i7 ,this     
coverage would be an equalizer for      
communities of color4 ,the maternal     
mortality rate varies drastically by    
race and ethnicity1 and where a woman   
lives4 ,the rising maternal mortality   
rate in the ,united ,states is driven   
predominantly by the disproportionately 
high ,african-,american maternal        
mortality rate1 which is four times more
 than the rate for ,white women4  7#aj7 
,according to the ,centers for ,disease 
,control and ,prevention1 about #gjj    
women die each year in the ,united      
,states from pregnancy-related          
complications4 ,black and ,american     
,indian_/,alaska ,native women are about
 three times more likely to die from a  
pregnancy-related cause than ,white     
women4  7#aa7 ,data demonstrates that #c

 in #e pregnancy-related deaths could be
 prevented4 ,improving access to care is
 one way to help prevent deaths1        
regardless of race or ethnicity4  7#ab7 
,timely maternity care improves the     
health of pregnant women1 as well as    
birth outcomes and the health of babies 
throughout their lifetimes4             
,pregnancy-related maternal mortality is
 three to four times higher among women 
who receive no maternity care compared  
to women who do4 ,regular maternity care
 can detect or mitigate serious         
pregnancy-related health complications1 
including preeclampsia1 placental       
abruption1 complications from diabetes1 
complications from heart disease1 and   
,graves' disease1 all of which can      
result in morbidity or mortality for the
 mother or newborn4  7#ac7 ,the ,centers
 for ,disease ,control and ,prevention  
reports that more than half of all      
maternal deaths occur at delivery or in 
the first postpartum year1 whereas just 
more than one-third of pregnancy-related

 or pregnancy-associated deaths occur   
while a person is still pregnant4 ,yet1 
for women eligible for the ,medicaid    
program on the basis of pregnancy1 such 
,medicaid coverage lapses at the end of 
the month on which the #fjth postpartum 
day lands4  7#ad7 ,timely maternity care
 and adequate postpartum care can reduce
 short- and long-term health care costs4
 ,if a woman does not have access to    
affordable maternity care during her    
pregnancy1 and she or her newborn       
experiences pregnancy complications that
 result in health problems after birth1 
their insurer may end up paying much    
higher costs than if the insurer had    
covered the woman's maternity care      
during her pregnancy4 ,intensive        
maternity care can reduce hospital and  
neonatal intensive care unit admissions 
among infants1 resulting in cost savings
 of #a1gfh to #e1efj per birth4 ,for    
women with high-risk pregnancies1       
intensive maternity care saves #a4cg for
 every #a invested in maternity care4   

7b7 ,purpose ,the purpose of this ,act  
is to protect the health of women and   
newborns by ensuring that all women     
eligible for coverage through the       
,exchanges established under title ,i of
 the ,patient ,protection and           
,affordable ,care ,act 7,public ,law    
#aaa-adh7 and women eligible for other  
individual or group health plan coverage
 can access affordable health coverage  
during their pregnancy4  #c4 ,providing 
for a special enrollment period for     
pregnant individuals  7a7 ,public       
,health ,service ,act ,section          
#bgjb7;b77#b7 of the ,public ,health    
,service ,act 7#db ,u4,s4,c4            
#cjj;gg-#a7;b77#b77 is amended by       
inserting including a special enrollment
 period for pregnant individuals1       
beginning on the date on which the      
pregnancy is reported to the health     
insurance issuer before the period at   
the end4  7b7 ,patient protection and   
affordable care act ,section            
#acaa7;c77#f7 of the ,patient           

,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjca7;c77#f77 is       
amended-- 7#a7 in subparagraph 7,c71 by 
striking and at the end2  7#b7 by       
redesignating subparagraph 7,d7 as      
subparagraph 7,e72 and  7#c7 by         
inserting after subparagraph 7,c7 the   
following new subparagraph3  7,d7 a     
special enrollment period for pregnant  
individuals1 beginning on the date on   
which the pregnancy is reported to the  
,exchange2 and  4  7c7 ,special         
enrollment periods  7#a7 ,internal      
,revenue ,code ,section #ihja7;f7 of the
 ,internal ,revenue ,code of #aihf 7#bf 
,u4,s4,c4 #ihja7;f77 is amended by      
adding at the end the following new     
paragraph3  7#d7 ,for pregnant          
individuals  7,a7 ,a group health plan  
shall permit an employee who is         
eligible1 but not enrolled1 for coverage
 under the terms of the plan 7or a      
dependent of such an employee if the    
dependent is eligible1 but not enrolled1
 for coverage under such terms7 to      

enroll for coverage under the terms of  
the plan upon pregnancy1 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
 provider4  7,b7 ,the ,secretary shall  
promulgate regulations with respect to  
the special enrollment period under     
subparagraph 7,a71 including            
establishing a time period for pregnant 
individuals to enroll in coverage and   
effective date of such coverage4  4     
7#b7 ,,erisa ,section #gja7;f7 of the   
,employee ,retirement ,income ,security 
,act of #aigd 7#bi ,u4,s4,c4 #aaha7;f77 
is amended by adding at the end the     
following3  7#d7 ,for pregnant          
individuals  7,a7 ,a group health plan  
or health insurance issuer in connection
 with a group health plan shall permit  
an employee who is eligible1 but not    
enrolled1 for coverage under the terms  
of the plan 7or a dependent of such an  
employee if the dependent is eligible1  

but not enrolled1 for coverage under    
such terms7 to enroll for coverage under
 the terms of the plan upon pregnancy1  
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 provider4  7,b7 ,the        
,secretary shall promulgate regulations 
with respect to the special enrollment  
period under subparagraph 7,a71         
including establishing a time period for
 pregnant individuals to enroll in      
coverage and effective date of such     
coverage4  4  7d7 ,effective date ,the  
amendments made by this section shall   
apply with respect to plan years        
beginning after the #bjai plan year4    
#d4 ,coverage of maternity care for     
dependent children ,section #bgai;,a of 
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #cjj;gg-#ai;a7 is amended by  
adding at the end the following3  7e7   
,coverage of maternity care ,a group    

health plan1 or health insurance issuer 
offering group or individual health     
insurance coverage1 that provides       
coverage for dependents shall ensure    
that such plan or coverage includes     
coverage for maternity care associated  
with pregnancy1 childbirth1 and         
postpartum care for all participants1   
beneficiaries1 or enrollees1 including  
dependents1 including coverage of labor 
and delivery4 ,such coverage shall be   
provided to all pregnant dependents     
regardless of age4  4  #e4 ,federal     
employee health benefit plans  7a7      
,coverage of pregnancy  7#a7 ,in general
 ,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 enroll1 but is not enrolled1 in a    
health benefit plan under chapter #hi   
title #e1 ,united ,states ,code4  7#b7  
,effective date ,the requirement in     

paragraph 7#a7 shall apply with respect 
to any contract entered into under      
section #hijb of such title beginning   
#ab months after the date of enactment  
of this ,act4  7b7 ,designating certain 
,,fehbp-,related services as excepted   
services under the ,anti-,deficiency    
,act  7#a7 ,in general ,section #hije of
 title #e1 ,united ,states ,code1 is    
amended by adding at the end the        
following3  7i7 ,any services by an     
officer or employee under this chapter  
relating to enrolling individuals in a  
health benefits plan under this chapter1
 or changing the enrollment of an       
individual already so enrolled due to an
 event described in section #e7;a77#a7  
of the ,healthy ,,mom ,act1 shall be    
deemed1 for purposes of section #acdb of
 title #ca1 services for emergencies    
involving the safety of human life or   
the protection of property4  4  7#b7    
,application ,the amendment made by     
paragraph 7#a7 shall apply to any lapse 
in appropriations beginning on or after 

the date of enactment of this ,act4  #f4
 ,continuation of ,medicaid income      
eligibility standard for pregnant       
individuals and infants ,section        
#aijb7l77#b77;,a7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;a7l77#b77;,a77 is amended-- 7#a7  
in clause 7i71 by striking and not more 
than #ahe percent2  7#b7 in clause      
7ii7-- 7,a7 in subclause 7,i71 by       
striking and after the comma2  7,b7 in  
subclause 7,,ii71 by striking the period
 at the end and inserting 1 and2 and    
7,c7 by adding at the end the following3
  7,,iii7 ,january #a1 #bjbj1 is the    
percentage provided under clause 7v74  2
 and  7#c7 by adding at the end the     
following new clause3  7v7 ,the         
percentage provided under clause 7ii7   
for medical assistance provided on or   
after ,january #a1 #bjbj1 with respect  
to individuals described in subparagraph
 7,a7 or 7,b7 of paragraph 7#a7 shall   
not be less than-- 7,i7 the percentage  
specified for such individuals by the   

,state in an amendment to its ,state    
plan 7whether approved or not7 as of    
,january #a1 #bjad2 or  7,,ii7 if no    
such percentage is specified as of      
,january #a1 #bjad1 the percentage      
established for such individuals under  
the ,state's authorizing legislation or 
provided for under the ,state's         
appropriations as of that date4  4  #g4 
#ab-month continuous coverage for       
pregnant and postpartum individuals     
under ,medicaid and ,,chip  7a7         
,medicaid  7#a7 ,required for all       
eligibility pathways ,paragraph 7#e7 of 
section #aijb7;e7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77 is amended to read as       
follows3  7#e7 ,any individual who is   
eligible for medical assistance under   
the ,state plan or a waiver of such plan
 and who is1 or who while so eligible   
becomes1 pregnant1 shall continue to be 
eligible under the plan or waiver for   
medical assistance that provides at     
least essential health benefits as      

described in section #acjb7;b7 of the   
,patient ,protection and ,affordable    
,care ,act1 through the end of the month
 in which the #a-year period 7beginning 
on the last day of her pregnancy7 ends1 
regardless of the basis for the         
individual's eligibility for medical    
assistance1 including if the            
individual's eligibility for medical    
assistance is on the basis of being     
pregnant4  4  7#b7 ,conforming          
amendments ,title ,,xix of the ,social  
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is amended-- 7,a7 in section      
#aijb-- 7i7 in subsection 7a77#aj71 in  
the matter following subparagraph 7,g7  
by striking 7,,vii7 the medical         
assistance and all that follows through 
complicate pregnancy12  7ii7 in         
subsection 7e77#f71 by striking #fj-;day
 and inserting #a-year2 and  7iii7 in   
subsection 7l77#a77;,a71 by striking    
#fj-;day and inserting #a-year2  7,b7 in
 section #aijc7v77#d77;,a77i71 by       
striking #fj-;day and inserting #a-year2

 and  7,c7 in section #aije7;a71 in the 
#dth sentence in the matter following   
paragraph 7#cj71 by striking #fj-;day   
and inserting #a-year4  7b7 ,,chip  7#a7
 ,in general ,section #bajg7;e77#a7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acig;gg7e77#a77 is amended-- 
7,a7 by redesignating subparagraphs 7,h7
 through 7,s7 as subparagraphs 7,i7     
through 7,t71 respectively2 and  7,b7 by
 inserting after subparagraph 7,g71 the 
following3  7,h7 ,section #aijb7;e77#e7 
7requiring #ab-month continuous coverage
 for pregnant individuals74  4  7#b7    
,conforming amendments ,subsections     
7d77#b77;,a7 and 7f77#b7 of section     
#baab of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acigll7 are each amended by 
striking #fj-;day and inserting #a-year4
  7c7 ,effective date  7#a7 ,in general 
,subject to paragraph 7#b71 the         
amendments made by this section shall   
take effect on the #ast day of the #ast 
calendar quarter that begins on or after
 the date that is #a year after the date

 of enactment of this ,act4  7#b7       
,exception for ,state legislation ,in   
the case of a ,state plan under title   
,,xix of the ,social ,security ,act or a
 ,state child health plan under title   
,,xxi of such ,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 section1 the respective    
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 ,act4    
,for purposes of the previous sentence1 
in the case of a ,state that has a      
#b-year legislative session1 each year  
of the session shall be considered to be
 a separate regular session of the      

,state legislature4  #h4 ,relationship  
to other laws ,nothing in this ,act 7or 
an amendment made by this ,act7 shall be
 construed to invalidate or limit the   
remedies1 rights1 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 issuer4