H.R. 9816: Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act (119th Congress) Bill Summary

The bill would make several changes to Medicaid and CHIP coverage for pregnant and postpartum people, as well as to how certain maternity-related and primary care services are paid for and studied.

Coverage Changes for Pregnancy and Postpartum Care

The bill would extend Medicaid and CHIP postpartum coverage to 12 months after pregnancy. It would require that people covered under this expanded postpartum period receive the full range of Medicaid benefits, including oral health services.

It would also prevent states from reducing coverage for pregnant people or postpartum individuals below the levels required under the bill.

Federal Funding for Expanded Coverage

The bill would provide a 100% federal matching rate for the additional costs of the expanded postpartum coverage and related benefits, meaning the federal government would fully cover those added expenses for states during the covered period.

Maternal Care Demonstration Project

The bill would create a demonstration project for a maternity care home model. This would test a coordinated care approach for pregnant and postpartum individuals, similar to a patient-centered medical home, with the goal of improving access and management of maternity care.

Medicaid Payment and Provider Rules

The bill would raise Medicaid primary care payment floors for certain providers and clarify which providers are covered under the payment rules. It would also require managed care plans that participate in Medicaid to properly pay specified primary care providers.

Reports, Guidance, and Studies

The bill would direct CMS and MACPAC to produce reports and guidance aimed at expanding Medicaid coverage of doula services, ensuring fair payment for those services, and examining the use of telehealth for maternity care. These directives would help inform future policy and implementation related to maternal health services.