MOMMIES Act
- Sponsor
- Sen. Booker, Cory A. [D-NJ]
- Committees
- Finance Committee (primary)
- Last action
- Jun 24, 2026
Bottom line
This bill aims to significantly enhance and expand access to comprehensive maternal and infant health services for low-income individuals through Medicaid and CHIP, focusing on continuous care, equitable outcomes, and provider support.
What it actually does
The bill extends Medicaid and CHIP coverage for pregnant and postpartum individuals to one year, mandates comprehensive benefits including oral health, and establishes a "Maternity Care Home Demonstration Project" to improve maternal and infant health outcomes. It also reinstates and expands a Medicare payment rate floor for primary care services under Medicaid, including for a broader range of providers, and mandates reports and guidance on doula services and telehealth in maternity care.
Proponents argue
Supporters argue that the bill addresses critical gaps in maternal healthcare, particularly for low-income individuals and communities of color, by extending postpartum coverage, ensuring access to essential services like oral health, and promoting integrated, culturally competent care models. They contend that these measures are vital to reducing maternal mortality and morbidity rates, improving birth equity, and supporting the health of both mothers and infants.
Opponents contend
Critics might argue that the bill imposes significant new financial burdens on states, even with enhanced federal matching funds, and could lead to increased federal spending without clear evidence of long-term cost-effectiveness. Concerns could also be raised about the administrative complexity of implementing the demonstration project and the expanded payment mandates, potentially straining state Medicaid agencies and healthcare providers.
The bill is moderately complex, requiring careful reading to understand the interplay of its various provisions. The estimated reading time of 45 minutes is reasonable for an informed reader to grasp its implications.
Section 2(a), (b)
Extended Continuous Medicaid and CHIP Coverage and Full Benefits for Pregnant and Postpartum Individuals
This provision amends Medicaid (Title XIX) and CHIP (Title XXI) to extend continuous eligibility for pregnant and postpartum individuals from the current 60-day period to a 1-year period (or longer, if a State chooses). During this extended period, individuals must receive full medical assistance benefits, meaning services that are not less in amount, duration, or scope than those available to other core Medicaid beneficiaries.
Supporters argue
Supporters argue that extending postpartum coverage to one year is crucial for addressing the maternal mortality crisis, as many pregnancy-related complications occur months after birth. Ensuring continuous access to full benefits allows for better management of chronic conditions, mental health issues, and recovery from childbirth, leading to improved maternal and infant health outcomes.
Critics contend
Critics may argue that while the goal is laudable, mandating a full year of coverage, even with enhanced federal funding, places an undue administrative and financial burden on states, potentially diverting resources from other essential state programs. They might also question the long-term sustainability of such a federal mandate.
Tradeoffs
The provision balances the federal goal of improving maternal health outcomes by ensuring continuous care against concerns about state autonomy and the administrative and fiscal implications for state Medicaid programs.
Section 2(c)
Required Coverage of Oral Health Services for Pregnant and Postpartum Individuals
This section amends Medicaid (Title XIX) to require states to cover oral health services for pregnant and postpartum individuals. These services must include dental care necessary to prevent disease, promote oral health, restore oral structures, and treat emergency conditions, consistent with recommendations from leading pediatric and obstetric organizations. A similar provision is made for CHIP.
Section 2(d)
Maintenance of Effort (MOE) for Low-Income Pregnant Individuals
This provision establishes maintenance of effort requirements for states. For Medicaid, states cannot impose more restrictive eligibility standards or reduce the scope of medical assistance for low-income pregnant individuals (under 1902(a)(10)(A)(ii)(IX)) than what was in effect on the date of enactment, for calendar quarters beginning on or after enactment and before January 1, 2027. A similar MOE applies to CHIP for targeted low-income pregnant individuals from January 1, 2027, to January 1, 2031.
Section 2(e)
Enhanced Federal Medical Assistance Percentage (FMAP) for New Requirements
This section provides a 100% Federal Medical Assistance Percentage (FMAP) for additional amounts expended by states for medical assistance under Medicaid or a waiver that are directly attributable to the new requirements imposed by this Act. This enhanced FMAP applies to calendar quarters beginning on or after January 1, 2027.
Section 3
Maternity Care Home Demonstration Project
This section establishes a 5-year demonstration project under Medicaid, requiring the Secretary to provide grants to at least 10 states (including at least one territory) to implement or expand a 'maternity care home model.' These models will provide coordinated, evidence-based, culturally and linguistically appropriate care through teams of healthcare professionals, focusing on improving maternal and infant outcomes, birth equity, and reducing disparities. States must partner with eligible entities like birth centers, FQHCs, and Indian health facilities.
Section 4
Reapplication and Expansion of Medicaid Primary Care Payment Rate Floor
This provision reinstates and expands a requirement for states to pay primary care providers under Medicaid at rates not less than 100% of Medicare Part B rates (or higher, based on a 2009 conversion factor). It broadens the definition of eligible primary care providers to include physicians in family medicine, internal medicine, pediatrics, OB/GYN, advanced practice clinicians (like NPs, PAs, CNMs, CPMs), rural health clinics, FQHCs, and other health centers. It also allows for increased rates (up to 25%) in rural, HPSA, or medically underserved areas and ensures managed care entities comply with these payment requirements.
Section 5
MACPAC Report and CMS Guidance on Increasing Access to Doula Services
This section mandates that the Medicaid and CHIP Payment and Access Commission (MACPAC) publish a report within one year on the coverage of doula services under State Medicaid programs. The report must analyze current coverage, barriers, effective strategies to increase doula use (including for diverse workforces), and recommendations for legislative and administrative actions to ensure sustainable living wages for doulas. Following this, the CMS Administrator must issue guidance to states on increasing access to doula services under Medicaid, including options for coverage and best practices for reimbursement and access.
The bill includes specific Maintenance of Effort (MOE) provisions that prevent states from making eligibility standards or benefits for low-income pregnant individuals more restrictive than they were on the date of enactment. These MOE provisions have different end dates for Medicaid (before Jan 1, 2027) and CHIP (before Jan 1, 2031).
Section 2(d)
Why it matters:This is standard legislative practice to ensure that new federal mandates or incentives do not lead to states rolling back existing protections. The staggered dates reflect different implementation timelines or political considerations for Medicaid versus CHIP.
Case for: Proponents argue that these MOE clauses are critical to prevent states from undermining the intent of the bill by cutting existing benefits or eligibility for pregnant individuals, ensuring that the new federal investments build upon, rather than replace, current state efforts.
Case against: Critics of MOE provisions often argue they limit state flexibility and autonomy in managing their healthcare programs and budgets, potentially hindering their ability to respond to unique state needs or fiscal challenges.
Estimated impact: Protects current eligibility and benefit levels for millions of low-income pregnant individuals in states, preventing potential reductions in access to care.
The bill significantly expands the definition of 'additional providers' eligible for the enhanced primary care payment floor under Medicaid. This includes not only physicians in family medicine, internal medicine, pediatrics, and OB/GYN, but also advanced practice clinicians (like nurse practitioners, physician assistants, certified nurse-midwives, and certified professional midwives) and various health clinics (rural health clinics, FQHCs, Title X centers).
Section 4(b)(2)
Why it matters:This is standard legislative practice for defining terms within a statute. However, the substantive impact of this definition is significant, as it broadens the scope of who benefits from higher reimbursement rates.
Case for: Proponents argue that including a wider range of primary care providers, especially advanced practice clinicians and midwives, is essential to address provider shortages, improve access to care in underserved areas, and recognize the critical role these professionals play in maternal and primary healthcare.
Case against: No specific opposition is typically raised against expanding the types of providers eligible for primary care reimbursement, especially when it aims to improve access. Concerns, if any, would be general fiscal ones about the increased federal and state spending.
Estimated impact: Potentially increases the number of providers willing to accept Medicaid patients for primary care, particularly in maternal health, and improves financial stability for a broader segment of the healthcare workforce.
The definition of 'primary care services' for the purpose of the enhanced payment floor explicitly excludes 'any services described in subparagraph (A) or (B) of paragraph (1) if such services are provided in an emergency department of a hospital.'
Section 4(b)(1)(B)
Why it matters:This is a technical clarification to prevent the higher primary care rates from being applied to services that, while potentially primary care in nature, are delivered in a high-cost emergency setting. It's a standard legislative technique to refine the scope of a provision.
Case for: Proponents argue that this exclusion is necessary to ensure that the enhanced payment rates are targeted specifically at primary care settings, where preventative and routine care is most cost-effective, rather than inadvertently subsidizing more expensive emergency department visits for non-emergent conditions.
Case against: No specific opposition is typically raised against this exclusion, as it aligns with efforts to encourage appropriate utilization of healthcare services and reduce unnecessary emergency department use.
Estimated impact: Prevents potentially significant federal and state expenditures that would result from applying enhanced primary care rates to emergency department services, thereby focusing resources on intended primary care settings.