Advancing Maternal Health Equity Under Medicaid Act
- Sponsor
- Rep. Williams, Nikema [D-GA-5]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Jun 25, 2025
Bottom line
This bill aims to incentivize states to expand and improve maternal health care services under Medicaid by significantly increasing the federal share of funding for new investments in this critical area.
What it actually does
This bill amends the Social Security Act to provide a higher federal matching rate (90%) for new or increased state Medicaid expenditures on a defined set of maternal health care services. These services include prenatal, labor, delivery, postpartum, telehealth, home visiting, and mental/behavioral health services, furnished by a broad range of providers and perinatal health workers. States must use these funds to supplement, not supplant, existing efforts and to improve the capacity, efficiency, and quality of maternal health care.
Proponents argue
Proponents argue that this bill will address the critical issue of maternal mortality and morbidity, particularly among underserved populations, by providing states with a strong financial incentive to expand access to comprehensive maternal health services. They emphasize that the higher FMAP will enable states to invest in a broader range of services and providers, including doulas and community health workers, which are crucial for achieving health equity and improving outcomes throughout the prenatal and postpartum periods.
Opponents contend
Opponents might express concerns about the potential for increased federal spending and the long-term fiscal implications of a higher matching rate. They could argue that while maternal health is important, this approach might create an open-ended federal commitment without sufficient accountability for outcomes, or that it could lead to states shifting existing funds to qualify for the higher match despite the 'supplement, not supplant' clause. Some might also prefer block grants or other funding mechanisms that offer states more flexibility.
The bill is concise and clearly written, making it accessible for a quick review by an informed reader.
Section 2(1) of the bill, amending Section 1903(a)(5) of the Social Security Act.
Enhanced Federal Matching Rate for Maternal Health Care Services
This provision increases the federal share of Medicaid funding for states that expand their spending on maternal health care services. Specifically, the federal government will pay 90% of the amounts by which a state's expenditures on these services exceed its spending for the same services during the corresponding quarter in the four-quarter period ending December 31, 2019. This enhanced match begins for calendar quarters starting on or after January 1 of the year following one year after the bill's enactment.
Supporters argue
Supporters argue that the 90% FMAP is a strong incentive for states to address maternal health disparities and improve outcomes, as it significantly reduces the state's financial burden for new investments in this critical area.
Critics contend
Critics might argue that such a high matching rate could lead to states overspending or shifting funds to qualify for the higher match, potentially distorting state budget priorities without guaranteeing improved outcomes.
Tradeoffs
The tension lies between providing a robust incentive for states to invest in maternal health and ensuring fiscal responsibility and effective use of federal funds.
Section 2(2) of the bill, adding new paragraph (6) to Section 1903(b) of the Social Security Act.
Conditions for Receiving Enhanced Federal Funds
This provision establishes two key conditions for states to receive the higher federal matching funds. First, states must use the new federal funds to supplement, not replace, their existing state funds for maternal health care services (as of January 1, 2023). Second, states must use these funds for activities that enhance the capacity, efficiency, and quality of maternal health care services.
Section 2(2) of the bill, adding new subparagraph (B)(i) to Section 1903(b)(6) of the Social Security Act.
Scope of Covered Maternal Health Care Services
This provision broadly defines 'maternal health care services' to include services furnished by maternity care providers or perinatal health workers. It explicitly lists prenatal, labor and delivery, and postpartum services (in various settings), telehealth services, home visiting services, and mental or behavioral health care services, all during the prenatal and postpartum periods. The postpartum period is defined as one year after the last day of pregnancy.
Section 2(2) of the bill, adding new subparagraphs (B)(ii) and (B)(iii) to Section 1903(b)(6) of the Social Security Act.
Expanded Provider Definitions for Maternal Health Services
This provision defines 'maternity care provider' to include physicians, physician assistants, midwives (meeting international standards), nurse practitioners, and clinical nurse specialists focused on maternal/perinatal health. It also defines 'perinatal health worker' to include doulas, community health workers, lactation educators, nutritionists, childbirth educators, social workers, home visitors, and language interpreters.
The baseline for calculating increased state expenditures eligible for the 90% FMAP is defined as the amounts expended for maternal health care services during the corresponding quarter in the four-quarter period ending on December 31, 2019.
Section 2(1)(B)(ii)
Why it matters:This is standard legislative practice for establishing a reference point for new spending incentives, often chosen to reflect pre-existing spending patterns or a specific policy window (e.g., pre-pandemic).
Case for: Supporters would argue that using a pre-pandemic baseline ensures that the enhanced FMAP genuinely incentivizes new investments in maternal health care beyond what states were already spending before recent public health challenges, and prevents states from simply getting a higher match for existing programs.
Case against: Critics might argue that a 2019 baseline doesn't account for changes in healthcare needs or costs that have occurred since then, potentially making it harder for states to demonstrate 'increased' expenditures if their baseline costs have naturally risen.
Estimated impact: This baseline directly determines the threshold states must exceed to qualify for the 90% federal match, thereby influencing the total amount of federal funds disbursed.