Healthy MOM Act
- Bill Number
- H.R. 6242
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, 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
- 2026-01-10T06:43:35Z
AI-Generated Summary
Purpose
The Healthy Maternity and Obstetric Medicine Act (Healthy MOM Act) aims to improve maternal and newborn health by ensuring pregnant women have access to affordable health insurance coverage. It addresses gaps in current coverage, such as limited enrollment options and exclusions for dependents, to reduce maternal mortality rates, prevent disparities (especially among communities of color), and promote timely prenatal, childbirth, and postpartum care. The bill emphasizes that better access to maternity services can prevent complications, lower long-term healthcare costs, and support healthier outcomes for mothers and babies.
Key Provisions
- Special Enrollment Period for Pregnancy: Creates a special window for pregnant individuals to enroll in health plans outside the standard open enrollment. This applies to:
- Health insurance Exchanges under the Affordable Care Act (ACA).
- Group health plans under employer-sponsored insurance.
- Individual health plans.
The enrollment period starts when pregnancy is reported to the insurer or confirmed by a healthcare provider. Regulations will define the exact timeframe and effective coverage date.
- Maternity Coverage for Dependents: Requires group and individual health plans that cover dependents (like children or young adults on a parent's plan) to include maternity care, including pregnancy, childbirth, labor, delivery, and postpartum services, regardless of the dependent's age.
- Federal Employee Health Benefits: Treats pregnancy as a "qualifying life event" (a change in family status) allowing eligible federal workers to enroll or change plans. It also protects enrollment services during government shutdowns by classifying them as emergency services under the Anti-Deficiency Act (a law preventing federal spending without appropriations).
- Medicaid Income Eligibility Lock-In: Maintains current state income eligibility thresholds for pregnant individuals and infants under Medicaid as of January 1, 2025, preventing reductions starting January 1, 2027.
- Extended Postpartum Coverage: Mandates 12 months of continuous Medicaid and Children's Health Insurance Program (CHIP) coverage for pregnant and postpartum individuals, replacing the previous 60-day postpartum period. This includes full benefits during pregnancy and the full postpartum year, and applies to both children and pregnant women in CHIP.
- Non-Preemption Clause: The law does not override stronger state or local protections for health plan enrollees.
Most provisions take effect for plan years beginning January 1, 2027, or one year after enactment (whichever applies), with flexibility for states needing legislative changes.
Significant Changes to Existing Law
- Amends the Public Health Service Act, ACA, Internal Revenue Code, Employee Retirement Income Security Act (ERISA, which governs employer-sponsored plans), Social Security Act (for Medicaid and CHIP), and federal employee benefits laws.
- Expands special enrollment periods beyond current triggers (e.g., marriage or job loss) to include pregnancy explicitly, which was not previously required in all plan types.
- Mandates maternity coverage for all dependents in plans that offer it, closing loopholes where young adult dependents (e.g., on student or catastrophic plans) might lack such benefits; this builds on ACA essential health benefits but enforces it more broadly.
- Makes 12-month postpartum coverage under Medicaid and CHIP mandatory nationwide (previously optional for states), extending from the prior 60-day standard.
- Locks in Medicaid eligibility percentages to prevent future cuts, a shift from allowing states more flexibility to adjust based on budgets.
- For federal plans, adds pregnancy as a qualifying event and provides shutdown protections, which were not explicitly covered before.
Potential Impacts
- On Citizens: Pregnant women, especially uninsured, low-income, or young adults, gain easier access to coverage, potentially reducing out-of-pocket costs, preventing 3 in 5 avoidable maternal deaths (per CDC data), and improving birth outcomes. It addresses racial disparities, as Black and Indigenous women face 3-4 times higher mortality risks. Newborns benefit from better prenatal care, reducing lifelong health issues.
- On Government Agencies: The Department of Health and Human Services (HHS) and Office of Personnel Management (OPM) must issue regulations and oversee implementation, increasing administrative workload. States administering Medicaid/CHIP may face higher short-term costs but long-term savings from preventive care (e.g., $1.37 saved per $1 invested in high-risk pregnancies). Federal shutdowns could see smoother enrollment processes.
- On Health Insurers and Employers: Insurers must offer new enrollment options and cover maternity for dependents, potentially raising premiums slightly but yielding savings from avoided complications (e.g., $1,768-$5,560 per birth in reduced hospital stays). Employers with group plans must comply, affecting plan design.
- International Relations: No direct impacts, as this is a domestic health policy focused on U.S. insurance and public programs.
Main Stakeholders Affected
- Pregnant Women and Families: Primary beneficiaries, including low-income, young adults, dependents, and communities of color facing higher maternal risks.
- Health Insurers and Plans: Must expand enrollment and coverage, including Exchanges, group plans, and individual markets.
- Employers: Responsible for updating group health plans under ERISA to include maternity for dependents.
- State and Federal Governments: States manage Medicaid/CHIP expansions; HHS and OPM handle regulations and federal employee benefits.
- Healthcare Providers: Gain more insured patients for prenatal and postpartum services, potentially increasing demand for obstetric care.
- Newborns and Children: Indirectly benefit through improved maternal health and extended CHIP coverage.
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces ACA essential health benefits (maternity as one of ten required services) and anti-discrimination laws (e.g., treating pregnancy differently is sex-based discrimination). Requires HHS and other agencies to promulgate regulations, which could face legal challenges if seen as overreach, but aligns with existing precedents like the Pregnancy Discrimination Act. The non-preemption clause preserves state autonomy for stronger protections.
- Constitutional: Supports equal protection under the 14th Amendment by addressing health disparities without infringing on states' rights (via delayed implementation for state legislation). No apparent free speech or due process issues.
- Political: Highlights bipartisan maternal health priorities (building on 2018 Preventing Maternal Deaths Act), but could spark debates on federal mandates versus state flexibility and costs to insurers/employers. It promotes equity in healthcare access, potentially influencing future reproductive health policies amid ongoing discussions on abortion and family planning post-Roe v. Wade. Long-term, it may reduce public health spending by preventing costly emergencies.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Watson Coleman, Bonnie [D-NJ-12]
Cosponsors (19)
Rep. Clarke, Yvette D. [D-NY-9], Rep. Carson, André [D-IN-7], Rep. Dean, Madeleine [D-PA-4], Rep. Evans, Dwight [D-PA-3], Rep. Fields, Cleo [D-LA-6], Rep. Frankel, Lois [D-FL-22], Rep. Gottheimer, Josh [D-NJ-5], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Jackson, Jonathan L. [D-IL-1], Rep. McIver, LaMonica [D-NJ-10], Rep. Moulton, Seth [D-MA-6], Rep. Pocan, Mark [D-WI-2], Rep. Sewell, Terri A. [D-AL-7], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Tlaib, Rashida [D-MI-12], Rep. Wilson, Frederica S. [D-FL-24], Rep. Thanedar, Shri [D-MI-13], Rep. Swalwell, Eric [D-CA-14], Rep. Hayes, Jahana [D-CT-5]
Recent Actions
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, 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.
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, 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.
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, 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.
- 2025-11-20: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, and Oversight and Government Reform, 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.
- 2025-11-20: Introduced in House
- 2025-11-20: Introduced in House
Bill Versions
- Healthy Maternity and Obstetric Medicine Act — issued 2025-11-20 — PDF (16 pages)