Keeping Obstetrics Local Act

Bill Number: H.R. 3942
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-06-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Last Updated: 2026-01-10T06:45:08Z

AI-Generated Summary

Purpose of the Legislation

The "Keeping Obstetrics Local Act" (H.R. 3942) aims to strengthen maternity care access in rural and underserved areas by providing enhanced financial support to hospitals offering labor and delivery services, expanding Medicaid and Children's Health Insurance Program (CHIP) coverage for pregnant and postpartum individuals, investing in the maternal health workforce, and improving transparency around hospital obstetric unit closures and data reporting. It targets vulnerable populations, such as low-income and rural residents, to prevent closures of essential services and improve maternal health outcomes.

Key Provisions

The bill is structured into four titles, amending titles XIX (Medicaid) and XXI (CHIP) of the Social Security Act, along with related provisions in the Public Health Service Act.

Title I: Enhancing Financial Support for Rural and Safety Net Hospitals Providing Obstetric Services

State Studies and HHS Report (Sec. 101): States must conduct studies every five years (starting 24 months after enactment) on costs of maternity, labor, and delivery services in "applicable hospitals" (rural hospitals with low birth volumes or those serving >50% Medicaid/CHIP births). Studies cover cost estimates, payment comparisons across programs (Medicare, Medicaid, CHIP, private insurance), and future expenditure projections. HHS compiles and reports on these, with $13 million appropriated for implementation and small hospital assistance.
Adequate Payment Rates Under Medicaid (Sec. 102): Starting FY 2027, Medicaid must pay "eligible hospitals" (rural, critical access, Indian Health Service, or high Medicaid/CHIP birth volume facilities) at least 150% of Medicare rates for maternity services in FY 2027, with adjustments every five years based on state studies. Applies to both fee-for-service and managed care; HHS issues rules defining services by July 1, 2026.
Increased Federal Financial Participation (FMAP) (Sec. 103): For eligible hospital maternity services starting October 1, 2026, federal matching is 100% for amounts above a base rate (adjusted for inflation from January 2025 rates), and enhanced FMAP (as in CHIP) for base amounts. Excludes territories from payment caps.
Labor and Delivery Anchor Payments (Sec. 104): Starting FY 2028, states must provide annual "anchor payments" to "low-volume obstetric hospitals" (<300 births/year on average) to cover a revenue floor (per-delivery amount of $10,000 indexed annually + $1.2 million standby capacity, revised every five years). Payments require contracts for service continuation, training, and fund use; states can recover payments for breaches. Federal match is enhanced FMAP; payments are additional to other reimbursements.
Application to CHIP (Sec. 105): Extends Medicaid payment and FMAP requirements to CHIP.
Disregarding Payments (Sec. 106): New payments do not count toward limits on other supplemental payments or upper payment limits.

Title II: Expand Coverage of Maternal Health Care

12-Month Continuous Coverage (Sec. 201): Mandates full Medicaid/CHIP benefits (not limited to pregnancy-related services) for pregnant individuals through the month 12 months postpartum ends, effective one year after enactment (states may opt earlier; legislation exception for states needing legislative changes).
Health Homes for Pregnant and Postpartum Women (Sec. 202): Optional state program starting January 1, 2028, for coordinated care via "maternity health homes" (providers/teams offering care plans, coordination, support services). Federal match is 90% for first eight quarters; includes planning grants ($50 million for FY 2027). Requires reporting on enrollment, outcomes, and data sharing; applies to CHIP.
Guidance on Doulas and Maternal Professionals (Sec. 203): HHS issues guidance within one year on state options to cover doulas, certified midwives (meeting international standards), and other professionals under Medicaid/CHIP, focusing on rural access, care models, and managed care.
Increased Support for Depression/Anxiety Screening (Sec. 204): Boosts FMAP by 1% in CHIP and applies Medicaid's expanded match for perinatal/postpartum screenings using validated tools, effective one year after enactment.
Presumptive Eligibility (Sec. 205): Mandates states offer temporary Medicaid eligibility determination for pregnant women by qualified entities (e.g., hospitals), without regard to other presumptive programs; effective immediately with conforming changes to CHIP.

Title III: Invest in the Maternal Health Care Workforce

Emergency Obstetric Workforce Support (Sec. 301): Expands Public Health Service Commissioned Corps deployment for "urgent maternal health care needs" (e.g., due to hospital closures or staff losses impacting access). Allows detailing personnel to states, localities, tribes, or nonprofits with reimbursement options and conditions (e.g., hiring plans). Authorizes $150 million annually starting FY 2027 for Corps operations, recruitment, and training in maternal care.
Streamlined Enrollment for Out-of-State Providers (Sec. 302): States must simplify screening/enrollment for neighboring-state providers of maternity services (low fraud risk, already screened for Medicare/other Medicaid) for five-year terms, effective January 1, 2028; includes CHIP and managed care guidance from HHS.

Title IV: Requiring Public Communication of Obstetrics Data and Unit Closures

Timely Notifications of Closures (Sec. 401): Hospitals must notify HHS, state/local agencies, and communities 180 days before closing obstetric units, including impact analysis, mitigation steps, causes, and transport costs. States must post reports publicly; effective 180 days after enactment.
Data Collection on Labor and Delivery (Sec. 402): Starting July 1, 2026, hospitals report in Medicare cost reports: birth numbers/types, transfers, staffing, expenses (e.g., nursing, on-call), and revenues by payer (Medicaid/CHIP, insured, uninsured).

Significant Changes to Existing Law

Payment Structures: Introduces minimum rates (150% of Medicare), 100% FMAP for enhanced portions, and anchor payments, shifting from optional to mandatory for eligible/low-volume hospitals; disregards these from other payment caps.
Coverage Duration: Changes Medicaid/CHIP pregnancy coverage from 60 days postpartum to 12 months full benefits, repealing pregnancy-only limits.
Workforce and Access: Mandates presumptive eligibility and out-of-state enrollment; expands Commissioned Corps for maternal emergencies; adds optional health homes with high federal match.
Reporting and Transparency: Requires state studies, closure notifications, and detailed cost/birth data in Medicare reports; applies similar rules to CHIP via conformity amendments.
Appropriations: Provides one-time funds ($13M for studies, $50M for health home planning) and ongoing ($150M/year for Corps).

Potential Impacts

Government Agencies: Increases HHS workload for guidance, reports, rulemaking, and Corps deployments; boosts federal Medicaid/CHIP spending (via higher FMAP/matches) but shares costs with states. States face new mandates for studies, payments, notifications, and data posting, potentially straining budgets but offset by federal funds.
Citizens: Improves access to maternity care for ~10-15 million annual pregnant Medicaid/CHIP enrollees, especially rural/low-income women, reducing closures and travel burdens. Enhances screening/treatment for postpartum mental health, presumptive eligibility speeds coverage, and health homes promote coordinated care, potentially lowering complications and costs long-term.
International Relations: None directly; focuses on domestic U.S. health policy, though tribal/Indian Health Service provisions support Native communities.

Main Stakeholders Affected

Hospitals and Providers: Rural/safety net hospitals gain financial stability to maintain services; doulas, midwives, and out-of-state providers get easier enrollment/coverage; Commissioned Corps expands maternal training.
Pregnant and Postpartum Individuals: Low-income, rural, and minority women benefit from extended coverage, coordinated care, and workforce support, addressing disparities in maternal mortality.
States and Localities: Must implement studies, payments, and notifications; eligible for planning grants and higher federal matches.
Federal Government (HHS): Oversees implementation, data analysis, and Corps operations.
Communities: Rural/underserved areas see preserved local obstetric units; taxpayers fund expansions via appropriations.

Notable Legal, Constitutional, or Political Implications

Legal: Strengthens Medicaid/CHIP as entitlements by mandating payments and coverage, potentially increasing litigation if states delay implementation (with built-in legislative exceptions). Aligns with existing anti-fraud screening (e.g., Medicare standards) and privacy rules (e.g., no disclosure of individual data).
Constitutional: No apparent challenges; promotes equal protection in health access for vulnerable groups without infringing states' rights (federal funding incentivizes compliance).
Political: Advances maternal health equity, a bipartisan priority amid rising U.S. maternal mortality (especially in rural areas). Could face debate over federal spending increases (~$200M initial + ongoing) and state burdens, but supports hospital sustainability post-COVID closures. Neutral on abortion, focusing on prenatal/postpartum care.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Bonamici, Suzanne [D-OR-1]

Cosponsors (1)

Rep. Kelly, Robin L. [D-IL-2]

Recent Actions

2025-06-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2025-06-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2025-06-12: Introduced in House
2025-06-12: Introduced in House

Bill Versions

Keeping Obstetrics Local Act — issued 2025-06-12 — PDF (79 pages)