Healthy MOM Act
- Bill Number
- S. 3274
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-20: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- Last Updated
- 2026-01-10T06:43:18Z
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 timely access to affordable health coverage. It addresses gaps in current insurance systems, such as limited enrollment options and exclusions for maternity care, to reduce maternal mortality risks, health disparities (especially among racial and ethnic minorities), and long-term costs for families and insurers.
Key Provisions
- Special Enrollment Period for Pregnant Individuals (SEC. 3): Creates a new enrollment window for pregnant people who are eligible but not currently enrolled in health plans. This applies to:
- Individual and small group plans under the Affordable Care Act (ACA) Exchanges.
- Employer-sponsored group 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. Applies to plan years starting January 1, 2027.
- Maternity Care Coverage for Dependents (SEC. 4): Requires group and individual health plans that cover dependents to include maternity care (pregnancy, childbirth, labor, delivery, and postpartum care) for all dependents, regardless of age. This prevents exclusions that treat pregnancy differently from other conditions. Applies to plan years starting January 1, 2027.
- Federal Employee Health Benefits (SEC. 5):
- Treats pregnancy as a "qualifying life event" (a change in family status) allowing eligible federal employees and dependents to enroll or change plans.
- Exempts enrollment-related services during government shutdowns (lapses in funding) from Anti-Deficiency Act restrictions, treating them as emergency services to protect health and safety. Effective one year after enactment for coverage; immediately for shutdown exemptions.
- Medicaid Income Eligibility Standards (SEC. 6): Maintains or freezes Medicaid income eligibility thresholds for pregnant individuals and infants at levels set by states as of January 1, 2025 (or via legislation/appropriations if unspecified). Prevents reductions below these levels starting January 1, 2027, ensuring continued access for low-income families.
- Extended Postpartum Coverage Under Medicaid and CHIP (SEC. 7): Mandates 12 months of continuous coverage for pregnant and postpartum individuals and infants under Medicaid and the Children's Health Insurance Program (CHIP). This replaces optional 60-day postpartum coverage and requires full benefits during pregnancy and the full postpartum period. States have up to one year after enactment to comply, with extra time if state laws need updating.
- Relationship to Other Laws (SEC. 8): The Act does not override or weaken any existing federal, state, or local laws that provide equal or stronger protections for health plan enrollees.
Significant Changes to Existing Law
- Expands special enrollment periods beyond current events (e.g., marriage, job loss) to include pregnancy, amending the Public Health Service Act, ACA, Internal Revenue Code, and Employee Retirement Income Security Act (ERISA, which governs employer plans).
- Mandates maternity coverage for all dependents in group plans, closing loopholes in plans that exclude young women or impose age limits, building on ACA essential health benefits (which already require maternity care but not always for dependents).
- Makes 12-month postpartum coverage mandatory (previously optional) under Medicaid and CHIP, extending beyond the standard 60 days and aligning with evidence that most maternal deaths occur postpartum.
- Freezes Medicaid eligibility to prevent future cuts, contrasting with past flexibility for states to adjust income limits.
- For federal plans, explicitly recognizes pregnancy as a qualifying event, which was not previously standardized.
Potential Impacts
- On Citizens: Increases access to prenatal, delivery, and postpartum care, potentially preventing 3 in 5 pregnancy-related deaths (per CDC data) by enabling early detection of complications like preeclampsia or diabetes. Reduces financial burdens from high-deductible plans or uncovered pregnancies, especially for young adults, low-income families, and communities of color facing higher mortality rates (e.g., Black women at 3-4 times the risk of White women).
- On Government Agencies: The Office of Personnel Management (OPM) must issue regulations for federal employee plans; states administering Medicaid/CHIP face new mandates, with federal funding implications but grace periods for compliance. Centers for Medicare & Medicaid Services (CMS) will oversee implementation.
- On Health Insurers and Employers: Requires plan adjustments, potentially increasing short-term costs but yielding savings from preventive care (e.g., $1.37 saved per $1 invested in high-risk pregnancies). No direct international relations impacts, as it focuses on domestic health policy.
Main Stakeholders Affected
- Pregnant Women and Dependents: Primary beneficiaries, including young adults on limited plans, low-income individuals via Medicaid/CHIP, and dependent daughters on employer plans.
- Newborns and Families: Gain from improved maternal health outcomes and continuous coverage.
- Health Insurers and Employers: Must update plans to include special enrollment and maternity benefits, affecting group and individual markets.
- Racial and Ethnic Minorities: Targeted for equity, addressing disparities in maternal mortality.
- States and Federal Government: States manage expanded Medicaid/CHIP requirements; federal agencies like OPM and HHS enforce rules.
- Healthcare Providers: Benefit from more insured patients accessing timely care.
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces anti-discrimination principles under laws like the Pregnancy Discrimination Act by ensuring pregnancy is not treated differently from other health conditions. Amendments to multiple statutes (e.g., ERISA, ACA) create enforceable uniformity across public and private plans, with regulations needed for details like enrollment timelines.
- Constitutional: Aligns with equal protection under the 14th Amendment by reducing racial and gender disparities in healthcare access; no apparent conflicts with federalism, as states retain flexibility in Medicaid administration post-grace period.
- Political: Sponsored by a bipartisan group of senators (mostly Democrats), it builds on prior laws like the Preventing Maternal Deaths Act (2018) and ACA essential benefits, signaling focus on public health equity amid rising U.S. maternal mortality. Could influence state-level policies and future healthcare reforms by prioritizing postpartum extensions and eligibility stability.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Sen. Alsobrooks, Angela D. [D-MD]
Cosponsors (14)
Sen. Baldwin, Tammy [D-WI], Sen. Blumenthal, Richard [D-CT], Sen. Cortez Masto, Catherine [D-NV], Sen. Fetterman, John [D-PA], Sen. Gillibrand, Kirsten E. [D-NY], Sen. King, Angus S., Jr. [I-ME], Sen. Klobuchar, Amy [D-MN], Sen. Merkley, Jeff [D-OR], Sen. Murray, Patty [D-WA], Sen. Van Hollen, Chris [D-MD], Sen. Booker, Cory A. [D-NJ], Sen. Duckworth, Tammy [D-IL], Sen. Kaine, Tim [D-VA], Sen. Shaheen, Jeanne [D-NH]
Recent Actions
- 2025-11-20: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2025-11-20: Introduced in Senate
Bill Versions
- Healthy Maternity and Obstetric Medicine Act — issued 2025-11-20 — PDF (16 pages)