Mamas First Act
- Sponsor
- Rep. Moore, Gwen [D-WI-4]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Jul 15, 2026
Bottom line
The Mamas First Act mandates Medicaid coverage for doula, midwife, and lactation support services nationwide, aiming to improve maternal health outcomes and reduce disparities.
What it actually does
This bill mandates that state Medicaid programs cover services provided by doulas, midwives (including tribal midwives), and lactation support providers. It defines the qualifications for these providers and prohibits states from imposing cost-sharing requirements on these services. The bill aims to address high maternal mortality rates, particularly among Black and Indigenous women, by expanding access to a broader range of maternal and postpartum care providers.
Proponents argue
Proponents argue that expanding Medicaid coverage for doulas, midwives, and lactation support providers is a critical step to combat the rising maternal mortality crisis in the United States, especially given the disproportionate impact on Black and Indigenous women. They cite evidence that these services lead to healthier outcomes for mothers and babies, including lower rates of low-birth-weight babies, fewer birth complications, and increased breastfeeding initiation, while also potentially reducing healthcare costs.
Opponents contend
Opponents, particularly some state officials and fiscal conservatives, may raise concerns about the financial implications of a new federal mandate on state Medicaid programs, even with federal matching funds. They might argue that states should retain flexibility in determining covered services and provider types, and that mandating coverage could strain state budgets or create administrative burdens in establishing new provider networks and reimbursement structures.
The bill is relatively short and clearly structured, making it accessible for an informed reader to understand its core provisions within a reasonable timeframe.
Section 3(a)(1)(C), amending Section 1905(a) of the Social Security Act
Mandatory Medicaid Coverage for Doula, Midwife, and Lactation Support Services
This provision adds services provided by doulas, midwives (including tribal midwives), and lactation support providers to the list of medical assistance that states must cover under their Medicaid programs. These services include prenatal, labor, and postpartum care, and can be provided in various settings like homes, hospitals, birth centers, clinics, or via telehealth, ensuring culturally congruent care.
Supporters argue
Supporters contend that mandating coverage is essential to address the severe maternal mortality crisis, particularly for marginalized communities, by making evidence-based support services more accessible. They argue that these providers offer holistic, culturally sensitive care that improves outcomes and reduces healthcare disparities.
Critics contend
Critics may argue that while the services are valuable, a federal mandate removes state flexibility and could impose significant financial and administrative burdens on states, especially those with limited existing infrastructure for these provider types.
Tradeoffs
The provision balances the federal goal of improving maternal health outcomes and reducing disparities with state autonomy and fiscal concerns regarding new mandates.
Section 3(a)(2), adding Section 1905(ll) to the Social Security Act
Definitions for Doulas, Midwives, Tribal Midwives, and Lactation Support Providers
This section establishes specific definitions and qualification criteria for doulas, midwives, tribal midwives, and lactation support providers for the purpose of Medicaid coverage. It allows for various pathways to qualification, including state authorization, national certification, recommendations from clients or licensed providers, or adherence to international or tribal standards, aiming to ensure both quality and accessibility of providers.
Section 3(b), amending Section 1902(a)(10)(A) of the Social Security Act
Mandatory Inclusion in State Medicaid Plans
This amendment explicitly adds the newly covered services (doula, midwife, tribal midwife, and lactation support provider services) to the list of medical assistance categories that states are *required* to include in their Medicaid plans. This reinforces the mandatory nature of the coverage, ensuring states cannot opt out of providing these services.
Section 3(c), amending Sections 1916 and 1916A of the Social Security Act
Prohibition on Cost-Sharing for Covered Services
This provision amends existing sections of the Social Security Act to explicitly prohibit states from imposing any cost-sharing requirements (such as deductibles, copayments, or coinsurance) on services provided by doulas, midwives, tribal midwives, or lactation support providers under Medicaid. This ensures that financial barriers do not prevent eligible individuals from accessing these services.
Section 3(d)
Effective Date and State Legislation Exception
The amendments made by this Act are set to apply to medical assistance furnished on or after January 1, 2027. However, it includes an exception for states that require legislative action to comply with the new requirements. For such states, the effective date is delayed until the first day of the first calendar quarter after the close of their first regular legislative session that begins after the Act's enactment, with a special rule for two-year legislative sessions.
The definition of 'doula' includes a pathway for individuals to qualify based on providing a recommendation from at least three former clients or two licensed health care providers within the last five years, in addition to certification.
Section 3(a)(2), adding Section 1905(ll)(1)(B) to the Social Security Act
Why it matters:This is standard legislative practice for defining specific criteria within a broader category, ensuring clarity on who qualifies for the new coverage.
Case for: Supporters argue this pathway is crucial for including experienced doulas who may not have formal certification but possess valuable practical experience and client satisfaction, particularly in communities where formal certification might be less accessible or culturally relevant. It broadens the pool of eligible providers.
Case against: Critics might contend that relying on client or provider recommendations without a standardized certification could lead to inconsistencies in quality assurance or make it more challenging for state Medicaid agencies to vet providers, potentially impacting program integrity.
Estimated impact: This provision significantly expands the potential pool of eligible doula providers, particularly those with community-based experience, increasing access to care.
The definition of 'tribal midwife' includes individuals recognized by an Indian tribe to practice midwifery for that tribe, alongside state authorization.
Section 3(a)(2), adding Section 1905(ll)(3)(B) to the Social Security Act
Why it matters:This is a deliberate inclusion to respect tribal sovereignty and traditional practices, ensuring that culturally specific healthcare providers are recognized within the federal framework.
Case for: Proponents emphasize that this provision is vital for providing culturally congruent care to American Indian and Alaskan Native women, who face some of the highest maternal mortality rates. It respects tribal self-determination in healthcare provision and acknowledges traditional healing practices.
Case against: No specific opposition is typically raised against provisions that recognize tribal sovereignty and traditional practices in healthcare, especially given the documented health disparities.
Estimated impact: This provision ensures that traditional tribal midwives can be reimbursed for their services under Medicaid, significantly improving access to culturally appropriate care for Indigenous communities.
The bill explicitly prohibits states from imposing cost-sharing (e.g., copayments, deductibles) for services provided by doulas, midwives, tribal midwives, or lactation support providers under Medicaid.
Section 3(c), amending Sections 1916 and 1916A of the Social Security Act
Why it matters:This is standard legislative drafting to integrate new policy into existing statutory frameworks, ensuring consistency with current law regarding cost-sharing exemptions for certain services.
Case for: Supporters argue that eliminating cost-sharing is essential to remove financial barriers for low-income individuals, ensuring that the expanded coverage translates into actual access and utilization of these vital maternal health services.
Case against: Some might argue that even nominal cost-sharing could help manage demand or contribute to state budgets, but this argument is generally not applied to preventative or essential maternal health services for vulnerable populations.
Estimated impact: This provision ensures that Medicaid beneficiaries face no out-of-pocket costs for these services, directly increasing their affordability and accessibility.