IMPACT to Save Moms Act
- Sponsor
- Rep. Schakowsky, Janice D. [D-IL-9]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- May 19, 2026
Bottom line
The bill establishes a federal demonstration project to innovate how states pay for maternity care through Medicaid and CHIP, with a strong focus on equity and improved outcomes for pregnant and postpartum individuals.
What it actually does
This bill directs the Administrator of the Centers for Medicare & Medicaid Services (CMS) to establish a five-year demonstration project (fiscal years 2027-2031) to test alternative payment models for maternity care under State Medicaid and Children's Health Insurance Programs (CHIP). The project aims to improve maternal health outcomes, particularly for demographic groups experiencing disparities, by considering factors like patient risk, social determinants of health, and diverse care teams including doulas and community health workers.
Proponents argue
Proponents argue that the current maternal healthcare system is failing, especially for women of color, leading to unacceptable rates of maternal mortality and severe morbidity. This bill offers a crucial opportunity to test innovative payment models that can address systemic inequities, integrate a broader range of support services like doulas, and focus on holistic care that includes mental health and social determinants, ultimately saving lives and improving health outcomes.
Opponents contend
Potential opponents might raise concerns about the expansion of federal oversight into state healthcare programs and the potential for increased federal spending without clear cost controls, given the 'such sums as are necessary' authorization. Some may argue that existing state-level initiatives or market-based solutions are sufficient, or express skepticism about the administrative complexity and burden on states and providers to implement new payment models.
The bill is short and relatively straightforward, making it accessible for an informed reader to evaluate its core provisions within a reasonable timeframe.
Section 2(a)
Establishment of Perinatal Care Alternative Payment Model Demonstration Project
This provision directs the Secretary of Health and Human Services, through the Administrator of CMS, to create a demonstration project from fiscal years 2027 through 2031. The project's goal is to allow states to test new payment models for maternity care provided to pregnant and postpartum individuals covered by their State Medicaid and CHIP plans.
Supporters argue
Supporters argue that this demonstration project is essential to identify and scale effective payment models that can address the U.S. maternal health crisis, particularly the disparities faced by certain demographic groups, by allowing states to experiment with innovative approaches.
Critics contend
Critics might contend that creating a new federal demonstration project adds another layer of bureaucracy and complexity to state Medicaid and CHIP programs, potentially diverting resources from direct care or creating administrative burdens for states.
Tradeoffs
The tension lies between the desire for innovation and flexibility at the state level versus the administrative overhead and potential for inconsistent outcomes across participating states during the demonstration phase.
Section 2(b)
Mandated Stakeholder Coordination
This section requires the Secretary to coordinate with a wide array of stakeholders when establishing the Demonstration Project. These include state Medicaid programs, various maternity care providers and organizations, patient advocacy groups (especially those focused on disparities), community-based organizations, perinatal health workers, health insurers, hospitals, birth centers, FQHCs, RHCs, and researchers.
Section 2(c)
Criteria for Alternative Payment Model Considerations
This provision outlines seven key considerations that the Secretary must take into account when evaluating alternative payment models for the demonstration project. These include improving outcomes for groups with disparities, risk stratification, evidence-based quality metrics, non-hospital birth settings, social determinants of health, diverse maternity care teams (including implicit bias training and perinatal health workers), and maternal mental health/substance use disorders.
Section 2(e) and 2(f)
Evaluation and Reporting Requirements
These provisions mandate a comprehensive evaluation of the demonstration project's impact on maternal health outcomes (with data stratified by race, ethnicity, language, socioeconomic status, geography, and insurance type), spending on maternity care, and patient experience. Following the evaluation, the Secretary must submit a public report to Congress with the results and a recommendation on whether to continue and expand the project nationally after 2031.
Section 2(g)
Key Definitions for Perinatal Care
This section defines several critical terms, including 'maternal mortality' (explicitly including suicide, overdose, and mental health/substance use disorders), 'maternity care provider' (broadly encompassing physicians, PAs, midwives, advanced practice registered nurses, state-accredited doulas, and lactation consultants), 'perinatal health worker' (e.g., doulas, community health workers, peer supporters), 'perinatal' (pregnancy through one year postpartum), 'postpartum' (one year after pregnancy), 'severe maternal morbidity' (including mental health/substance use disorders), and 'social determinants of maternal health'.
The bill explicitly includes state-accredited doulas and lactation consultants certified by the International Board of Lactation Consultant Examiners as 'maternity care providers,' and further defines 'perinatal health worker' to include doulas, community health workers, peer supporters, and lactation educators/counselors.
Section 2(g)(3)(A) and 2(g)(5)
Why it matters:This is standard legislative practice for defining terms. However, the specific inclusion of these roles is a significant policy choice that might be overlooked if not highlighted.
Case for: Supporters argue that integrating doulas, lactation consultants, and other perinatal health workers into formal healthcare payment models is essential for providing holistic, culturally competent care, especially for underserved communities. These professionals have been shown to improve maternal and infant outcomes, reduce disparities, and provide critical support often missing in traditional medical settings.
Case against: Some might argue that expanding the definition of 'maternity care provider' to include non-clinical roles could lead to increased costs or administrative complexities in credentialing and reimbursement. Concerns about quality control or scope of practice for these roles might also be raised, though the bill specifies 'state-accredited' for doulas and 'certified' for lactation consultants.
Estimated impact: Potentially significant, as it could open up new avenues for federal reimbursement for these services in participating states, increasing access to these supports for Medicaid/CHIP beneficiaries.
The bill mandates that alternative payment models be designed to improve maternal health outcomes for individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, or disparities, and that the evaluation data be stratified by race, ethnicity, primary language, socioeconomic status, geography, and insurance type.
Section 2(c)(1) and 2(e)(1)
Why it matters:This is a core policy objective, but the details of how it's operationalized are embedded within broader lists of requirements, making its centrality easy to miss.
Case for: Proponents argue that this explicit focus and data requirement are critical to ensure the demonstration project directly confronts and measures progress on racial and ethnic disparities in maternal health, which are a driving force behind the U.S. maternal health crisis. Without this, models might inadvertently perpetuate or worsen existing inequities.
Case against: Some might argue that requiring such detailed data stratification adds significant administrative burden to states and providers, potentially making participation less attractive or leading to incomplete data if systems are not robust enough. Concerns about data privacy or the feasibility of collecting all specified demographic data might also be raised.
Estimated impact: High, as it fundamentally shapes the design, targeting, and assessment of all payment models tested, ensuring an equity-first approach.