Mental Health and MAMA Act of 2026
- Sponsor
- Rep. Moore, Gwen [D-WI-4]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Jan 22, 2026
Bottom line
This bill aims to remove financial barriers to critical mental health and substance use disorder care for pregnant and new parents by eliminating out-of-pocket costs for these services and extending continuity of care protections.
What it actually does
This bill mandates that group health plans and health insurance issuers provide mental health and substance use disorder services without imposing any cost-sharing requirements for pregnant individuals and for a one-year period following pregnancy. This includes telehealth services and applies to services furnished by in-network providers. The bill achieves this by amending the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986, ensuring broad application across various health plan types. It also expands continuity of care protections for these individuals.
Proponents argue
Proponents argue that this bill addresses a critical gap in healthcare access for a vulnerable population, recognizing the heightened risk of mental health and substance use disorders during and after pregnancy. By eliminating cost-sharing, it will encourage more individuals to seek timely and necessary care, thereby improving maternal and infant health outcomes, reducing health disparities, and supporting family well-being.
Opponents contend
Opponents might argue that mandating zero cost-sharing could increase premiums for all plan participants or shift costs to other services, potentially making health insurance less affordable overall for a broader population. Concerns could also be raised about the administrative burden on health plans and issuers to implement these changes, and the potential for overutilization of services without any financial deterrent.
The bill is relatively short and clearly written, making it accessible for an informed reader to understand its core provisions within a reasonable timeframe.
Section 2(a)(1), adding new Section 2799A-11 to the Public Health Service Act.
Mandate Zero Cost-Sharing for Perinatal Mental Health and Substance Use Disorder Services (PHSA)
This provision requires group health plans and health insurance issuers offering group or individual coverage to eliminate all cost-sharing (e.g., co-pays, deductibles, coinsurance) for in-network mental health and substance use disorder services, including telehealth, for individuals from the diagnosis of pregnancy through one year postpartum. This mandate takes effect for plan years beginning two years after the bill's enactment, ensuring that financial barriers to critical care are removed for this vulnerable population.
Supporters argue
Supporters argue this provision directly addresses financial barriers that often prevent pregnant and postpartum individuals from accessing crucial mental health and substance use disorder care, leading to better health outcomes for both parents and infants by promoting early and continuous treatment.
Critics contend
Critics might contend that while well-intentioned, this mandate could lead to higher premiums for all policyholders or increased costs for employers sponsoring group plans, potentially making healthcare less affordable for others by shifting costs.
Tradeoffs
The tradeoff is between improving access to specific critical services for a vulnerable population by eliminating out-of-pocket costs, versus the potential for increased overall healthcare costs or premiums for other beneficiaries.
Section 2(b)(1), adding new Section 726 to the Employee Retirement Income Security Act of 1974.
Extend Zero Cost-Sharing Mandate to ERISA-Governed Group Health Plans
This provision mirrors the Public Health Service Act amendment by applying the same zero cost-sharing requirement for in-network mental health and substance use disorder services (including telehealth) for pregnant and one-year postpartum individuals to group health plans governed by ERISA. This ensures consistent application of the mandate across a significant portion of employer-sponsored health plans, providing equitable access to care.
Section 2(c)(1), adding new Section 9826 to the Internal Revenue Code of 1986.
Apply Zero Cost-Sharing Mandate to Group Health Plans under the Internal Revenue Code
This provision extends the zero cost-sharing requirement for in-network mental health and substance use disorder services (including telehealth) for pregnant and one-year postpartum individuals to group health plans as defined under the Internal Revenue Code. This ensures that the mandate is enforced through tax law, providing another layer of regulatory oversight and ensuring broad compliance across the diverse landscape of group health plans.
Section 2(a)(2), amending Section 2799A-3 of the Public Health Service Act.
Expand Continuity of Care Protections for Pregnant and Postpartum Individuals (PHSA)
This amendment expands existing continuity of care provisions to specifically include individuals who are pregnant and undergoing a course of treatment, as well as those who require mental health or substance use disorder services following a pregnancy, provided they received treatment from the same provider while pregnant and the pregnancy ended within the previous year. This ensures that individuals can continue care with their existing providers during these critical periods, even if their health plan or network changes.
Section 2(b)(2), amending Section 718 of the Employee Retirement Income Security Act of 1974.
Extend Continuity of Care Protections to ERISA-Governed Plans
This provision applies the same expanded continuity of care protections for pregnant and postpartum individuals to group health plans governed by ERISA. This ensures that participants and beneficiaries in employer-sponsored plans also benefit from the ability to maintain care with their existing mental health and substance use disorder providers during the perinatal period, even if their plan or network changes, providing a consistent safety net.
Section 2(c)(2), amending Section 9818 of the Internal Revenue Code of 1986.
Apply Continuity of Care Protections to Group Health Plans under the Internal Revenue Code
This provision extends the expanded continuity of care protections for pregnant and postpartum individuals to group health plans as defined under the Internal Revenue Code. This ensures that these plans are also subject to the requirements for allowing individuals to continue treatment with their mental health and substance use disorder providers during the perinatal period, reinforcing the mandate through tax law and ensuring broad compliance.
The bill requires cost-sharing to be waived 'from the diagnosis of pregnancy (as defined by the Secretary)'. The precise definition of 'diagnosis of pregnancy' is not provided in the bill text but is delegated to the Secretary.
Section 2(a)(1) (PHSA), Section 2(b)(1) (ERISA), Section 2(c)(1) (IRC)
Why it matters:This is standard legislative practice to allow federal agencies flexibility in implementing and updating definitions based on medical consensus, evolving practices, and practical considerations, rather than codifying potentially rigid definitions directly in statute.
Case for: Supporters would argue that delegating this definition to the Secretary allows for expert-driven, medically appropriate, and adaptable criteria for when pregnancy is officially diagnosed, ensuring the policy remains relevant as medical practices evolve and avoiding legislative rigidity.
Case against: Critics might argue that leaving such a key definition to regulatory discretion introduces uncertainty for both patients and health plans, and could lead to delays or disputes if the definition is not clearly or promptly established, potentially impacting access to benefits.
Estimated impact: This definition will determine the precise start date for the zero cost-sharing period for potentially millions of individuals, directly affecting when their financial benefits begin.
The new requirements for zero cost-sharing and expanded continuity of care will apply to plan years (or contract years for FEHBP) beginning on or after the date that is 2 years after the date of enactment of this section.
Section 2(a)(1), 2(b)(1), 2(c)(1), 2(d)(2)
Why it matters:This is standard legislative practice to provide health plans, issuers, and employers with sufficient time to update their systems, policies, and contracts to comply with new federal mandates, ensuring a smoother transition and minimizing disruptions.
Case for: Proponents would argue that this two-year lead time is essential for smooth and effective implementation, allowing all stakeholders to adjust without undue burden, thereby minimizing potential disruptions to coverage and ensuring robust compliance.
Case against: Critics might argue that a two-year delay postpones critical access to care and financial relief for a vulnerable population, potentially leaving many without needed benefits for an extended period despite the recognized urgency of maternal mental health needs.
Estimated impact: This provision delays the impact of the bill's core benefits for two years, affecting all individuals who would otherwise benefit during that period by continuing to face cost-sharing for mental health and SUD services.