Healthy MOMMIES Act

I 116TH CONGRESS 1ST SESSION H. R. 2602 To amend titles XIX and XXI of the Social Security Act to improve Medicaid and the Children’s Health Insurance Program for low-income mothers. IN THE HOUSE OF REPRESENTATIVES MAY 8, 2019 Ms. PRESSLEY (for herself, Ms. ADAMS, and Ms. UNDERWOOD) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend titles XIX and XXI of the Social Security Act to improve Medicaid and the Children’s Health Insurance Program for low-income mothers. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Healthy MOMMIES 4 Act’’. 5 SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR 6 LOW-INCOME PREGNANT WOMEN. 7 (a) EXTENDING CONTINUOUS MEDICAID AND CHIP 8 COVERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 9 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 2 •HR 2602 IH (1) MEDICAID.—Title XIX of the Social Secu- 1 rity Act (42 U.S.C. 1396 et seq.) is amended— 2 (A) in section 1902(l)(1)(A), by striking 3 ‘‘60-day period’’ and inserting ‘‘365-day pe- 4 riod’’; 5 (B) in section 1902(e)(6), by striking ‘‘60- 6 day period’’ and inserting ‘‘365-day period’’; 7 (C) in section 1903(v)(4)(A)(i), by striking 8 ‘‘60-day period’’ and inserting ‘‘365-day pe- 9 riod’’; and 10 (D) in section 1905(a), in the 4th sentence 11 in the matter following paragraph (30), by 12 striking ‘‘60-day period’’ and inserting ‘‘365- 13 day period’’. 14 (2) CHIP.—Section 2112 of the Social Security 15 Act (42 U.S.C. 1397ll) is amended by striking ‘‘60- 16 day period’’ each place it appears and inserting 17 ‘‘365-day period’’. 18 (b) REQUIRING FULL BENEFITS FOR PREGNANT 19 AND POSTPARTUM WOMEN.— 20 (1) MEDICAID.— 21 (A) IN GENERAL.—Paragraph (5) of sec- 22 tion 1902(e) of the Social Security Act (24 23 U.S.C. 1396a(e)) is amended to read as follows: 24 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 3 •HR 2602 IH ‘‘(5) Any woman who is eligible for medical as- 1 sistance under the State plan or a waiver of such 2 plan and who is, or who while so eligible becomes, 3 pregnant, shall continue to be eligible under the plan 4 or waiver for medical assistance through the end of 5 the month in which the 365-day period (beginning 6 on the last day of her pregnancy) ends, regardless 7 of the basis for the woman’s eligibility for medical 8 assistance, including if the woman’s eligibility for 9 medical assistance is on the basis of being preg- 10 nant.’’. 11 (B) CONFORMING AMENDMENT.—Section 12 1902(a)(10) of the Social Security Act (42 13 U.S.C. 1396a(a)(10)) is amended in the matter 14 following subparagraph (G) by striking ‘‘(VII) 15 the medical assistance’’ and all that follows 16 through ‘‘complicate pregnancy,’’. 17 (2) CHIP.—Section 2107(e)(1) of the Social 18 Security Act (42 U.S.C. 1397gg(e)(1)) is amended— 19 (A) by redesignating subparagraphs (H) 20 through (S) as subparagraphs (I) through (T), 21 respectively; and 22 (B) by inserting after subparagraph (G), 23 the following: 24 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 4 •HR 2602 IH ‘‘(H) Section 1902(e)(5) (requiring 365- 1 day continuous coverage for pregnant and 2 postpartum women).’’. 3 (c) REQUIRING COVERAGE OF ORAL HEALTH SERV- 4 ICES FOR PREGNANT AND POSTPARTUM WOMEN.— 5 (1) MEDICAID.—Section 1905 of the Social Se- 6 curity Act (42 U.S.C. 1396d) is amended— 7 (A) in subsection (a)(4)— 8 (i) by striking ‘‘; and (D)’’ and insert- 9 ing ‘‘; (D)’’; and 10 (ii) by inserting ‘‘; and (E) oral health 11 services for pregnant and postpartum 12 women (as defined in subsection (ff))’’ 13 after ‘‘subsection (bb))’’; and 14 (B) by adding at the end the following new 15 subsection: 16 ‘‘(ff) ORAL HEALTH SERVICES FOR PREGNANT AND 17 POSTPARTUM WOMEN.— 18 ‘‘(1) IN GENERAL.—For purposes of this title, 19 the term ‘oral health services for pregnant and 20 postpartum women’ means dental services necessary 21 to prevent disease and promote oral health, restore 22 oral structures to health and function, and treat 23 emergency conditions that are furnished to a woman 24 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 5 •HR 2602 IH during pregnancy (or during the 365-day period be- 1 ginning on the last day of the pregnancy). 2 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 3 the requirement to provide oral health services for 4 pregnant and postpartum women, a State shall, at 5 a minimum, provide coverage for preventive, diag- 6 nostic, periodontal, and restorative care consistent 7 with recommendations for perinatal oral health care 8 and dental care during pregnancy from the Amer- 9 ican Academy of Pediatric Dentistry and the Amer- 10 ican College of Obstetricians and Gynecologists.’’. 11 (2) CHIP.—Section 2103(c)(5)(A) of the Social 12 Security Act (42 U.S.C. 1397cc(c)(5)(A)) is amend- 13 ed by inserting ‘‘or a targeted low-income pregnant 14 woman’’ after ‘‘targeted low-income child’’. 15 (d) MAINTENANCE OF EFFORT.— 16 (1) MEDICAID.—Section 1902 of the Social Se- 17 curity Act (42 U.S.C. 1396a) is amended— 18 (A) in paragraph (74), by striking ‘‘sub- 19 section (gg); and’’ and inserting ‘‘subsections 20 (gg) and (qq);’’; and 21 (B) by adding at the end the following new 22 subsection: 23 ‘‘(qq) MAINTENANCE OF EFFORT RELATED TO LOW- 24 INCOME PREGNANT WOMEN.—For calendar quarters be- 25 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 6 •HR 2602 IH ginning on or after the date of enactment of this sub- 1 section, and before January 1, 2023, no Federal payment 2 shall be made to a State under section 1903(a) for 3 amounts expended under a State plan under this title or 4 a waiver of such plan if the State— 5 ‘‘(1) has in effect under such plan eligibility 6 standards, methodologies, or procedures (including 7 any enrollment cap or other numerical limitation on 8 enrollment, any waiting list, any procedures designed 9 to delay the consideration of applications for enroll- 10 ment, or similar limitation with respect to enroll- 11 ment) for individuals described in subsection (l)(1) 12 who are eligible for medical assistance under the 13 State plan or waiver under subsection 14 (a)(10)(A)(ii)(IX) that are more restrictive than the 15 eligibility standards, methodologies, or procedures, 16 respectively, for such individuals under such plan or 17 waiver that are in effect on the date of the enact- 18 ment of the Healthy MOMMIES Act; or 19 ‘‘(2) provides medical assistance to individuals 20 described in subsection (l)(1) who are eligible for 21 medical assistance under such plan or waiver under 22 subsection (a)(10)(A)(ii)(IX) at a level that is less 23 than the level at which the State provides such as- 24 sistance to such individuals under such plan or waiv- 25 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 7 •HR 2602 IH er on the date of the enactment of the Healthy 1 MOMMIES Act.’’. 2 (2) CHIP.—Section 2112 of the Social Security 3 Act (42 U.S.C. 1397ll), as amended by subsection 4 (b), is further amended by adding at the end the fol- 5 lowing subsection: 6 ‘‘(g) MAINTENANCE OF EFFORT.—For calendar 7 quarters beginning on or after January 1, 2020, and be- 8 fore January 1, 2023, no payment may be made under 9 section 2105(a) with respect to a State child health plan 10 if the State— 11 ‘‘(1) has in effect under such plan eligibility 12 standards, methodologies, or procedures (including 13 any enrollment cap or other numerical limitation on 14 enrollment, any waiting list, any procedures designed 15 to delay the consideration of applications for enroll- 16 ment, or similar limitation with respect to enroll- 17 ment) for targeted low-income pregnant women that 18 are more restrictive than the eligibility standards, 19 methodologies, or procedures, respectively, under 20 such plan that are in effect on the date of the enact- 21 ment of the Healthy MOMMIES Act; or 22 ‘‘(2) provides pregnancy-related assistance to 23 targeted low-income pregnant women under such 24 plan at a level that is less than the level at which 25 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 8 •HR 2602 IH the State provides such assistance to such women 1 under such plan on the date of the enactment of the 2 Healthy MOMMIES Act.’’. 3 (e) ENHANCED FMAP.—Section 1905 of the Social 4 Security Act (42 U.S.C. 1396d), as amended by sub- 5 section (c), is further amended— 6 (1) in subsection (b), by striking ‘‘and (aa)’’ 7 and inserting ‘‘(aa), and (gg)’’; and 8 (2) by adding at the end the following: 9 ‘‘(gg) INCREASED FMAP FOR ADDITIONAL EXPEND- 10 ITURES FOR LOW-INCOME PREGNANT WOMEN.—For cal- 11 endar quarters beginning on or after January 1, 2020, 12 notwithstanding subsection (b), the Federal medical as- 13 sistance percentage for a State, with respect to the addi- 14 tional amounts expended by such State for medical assist- 15 ance under the State plan under this title or a waiver of 16 such plan that are attributable to requirements imposed 17 by the amendments made by the Healthy MOMMIES Act 18 (as determined by the Secretary), shall be equal to 100 19 percent.’’. 20 (f) GAO STUDY AND REPORT.— 21 (1) IN GENERAL.—Not later than 1 year after 22 the date of the enactment of this Act, the Comp- 23 troller General of the United States shall submit to 24 Congress a report on the gaps in coverage for— 25 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 9 •HR 2602 IH (A) pregnant women under the Medicaid 1 program under title XIX of the Social Security 2 Act (42 U.S.C. 1396 et seq.) and the Children’s 3 Health Insurance Program under title XXI of 4 the Social Security Act (42 U.S.C. 1397aa et 5 seq.); and 6 (B) postpartum women under the Medicaid 7 program and the Children’s Health Insurance 8 Program who received assistance under either 9 such program during their pregnancy. 10 (2) CONTENT OF REPORT.—The report re- 11 quired under this subsection shall include the fol- 12 lowing: 13 (A) Information about the abilities and 14 successes of State Medicaid agencies in deter- 15 mining whether pregnant and postpartum 16 women are eligible under another insurance af- 17 fordability program, and in transitioning any 18 such women who are so eligible to coverage 19 under such a program, pursuant to section 20 435.1200 of the title 42, Code of Federal Regu- 21 lations (as in effect on September 1, 2018). 22 (B) Information on factors contributing to 23 gaps in coverage that disproportionately impact 24 underserved populations, including low-income 25 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 10 •HR 2602 IH women, women of color, women who reside in a 1 health professional shortage area (as defined in 2 section 332(a)(1)(A) of the Public Health Serv- 3 ice Act (42 U.S.C. 254e(a)(1)(A))) or who are 4 members of a medically underserved population 5 (as defined by section 330(b)(3) of such Act 6 (42 U.S.C. 254b(b)(3)(A))). 7 (C) Recommendations for addressing and 8 reducing such gaps in coverage. 9 (D) Such other information as the Comp- 10 troller General deems necessary. 11 (g) EFFECTIVE DATE.—The amendments made by 12 subsections (a) and (b) shall take effect January 1, 2020. 13 SEC. 3. MATERNITY CARE HOME DEMONSTRATION 14 PROJECT. 15 Title XIX of the Social Security Act (42 U.S.C. 1396 16 et seq.) is amended by inserting the following new section 17 after section 1946: 18 ‘‘MATERNITY CARE HOME DEMONSTRATION PROJECT 19 ‘‘SEC. 1947. (a) IN GENERAL.—Not later than 1 year 20 after the date of the enactment of this section, the Sec- 21 retary shall establish a demonstration project (in this sec- 22 tion referred to as the ‘demonstration project’) under 23 which the Secretary shall provide grants to States to enter 24 into arrangements with eligible entities to implement or 25 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 11 •HR 2602 IH expand a maternity care home model for eligible individ- 1 uals. 2 ‘‘(b) DEFINITIONS.—In this section: 3 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en- 4 tity’ means an entity or organization that provides 5 medically accurate, comprehensive maternity services 6 to individuals who are eligible for medical assistance 7 under a State plan under this title or a waiver of 8 such a plan, and may include: 9 ‘‘(A) A freestanding birth center. 10 ‘‘(B) An entity or organization receiving 11 assistance under section 330 of the Public 12 Health Service Act. 13 ‘‘(C) A federally qualified health center. 14 ‘‘(D) A rural health clinic. 15 ‘‘(E) A health facility operated by an In- 16 dian tribe or tribal organization (as those terms 17 are defined in section 4 of the Indian Health 18 Care Improvement Act). 19 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 20 individual’ means a pregnant woman or a formerly 21 pregnant woman during the 365-day period begin- 22 ning on the last day of her pregnancy who is— 23 VerDate Sep 11 2014 22:37 May 15, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 \\ALPHA3\E\BILLS\H2602.IH H2602 kjohnson on DSK79L0C42 with BILLS 12 •HR 2602 IH ‘‘(A) enrolled in a State plan under this 1 title, a waiver of such a plan, or a State child 2 health plan under title XXI; and 3 ‘‘(B) a patient of an eligible entity which 4 has entered into an arrangement with a State 5 under subsection (g). 6 ‘‘(c) GOALS OF DEMONSTRATION PROJECT.—The 7 goals of the demonstration project are the following: 8 ‘‘(1) To improve— 9 ‘‘(A) maternity and infant care outcomes; 10 ‘‘(B) health equity; 11 ‘‘(C) communication by maternity, infant 12 care, and social services providers; 13 ‘‘(D) integration of perinatal support serv- 14 ices, including community health workers, 15 doulas, social workers, public health nurses, 16 peer lactation counselors, childbir [Text truncated for display. 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