HR-6303-119
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Robin Kelly (D-IL)
What it does
The bill would require every state Medicaid and CHIP program to cover pregnant and postpartum women for 12 months after pregnancy and to cover oral health services for them, with a 5-year bar on making pregnancy-related eligibility rules stricter. It would raise the federal share of Medicaid and CHIP costs for extended postpartum coverage (100 percent for the first 20 quarters, then 90 percent) and set a 90 percent federal share for obstetric and gynecological services at rural hospitals. It would also create or fund several grant programs: state perinatal quality collaboratives (up to $250,000 per grant per year, $35 million per year authorized for fiscal years 2026-2030), regional centers on implicit bias training ($5 million per year authorized), a doula workforce program ($50 million appropriated for fiscal year 2026), and a rural obstetric mobile health unit pilot ($10 million per year authorized, with a bar on sharing identifiable patient data with law enforcement). It would require hospitals in Medicare to give the Secretary of Health and Human Services 90 days' notice, with a community impact report, before closing an obstetric unit; would allow states to certify WIC postpartum women for 2 years; would require a report on maternal health needs; and would raise federal excise taxes on roll-your-own, pipe, and smokeless tobacco (the visible text is cut off partway through this tax section, and other limits apply).
Who benefits
Pregnant and postpartum Medicaid and CHIP enrollees, who would gain guaranteed 12-month coverage and dental benefits in every state. Rural hospitals and rural patients, through the higher federal payment share and mobile units. Doulas and doula trainees, perinatal quality collaboratives, and health schools and nonprofits that could receive grants. States with the option that now lack extended coverage, since the federal government would pay 90 to 100 percent of the extension cost. Black, American Indian, and rural mothers, whom the bill targets because of higher reported mortality rates. WIC participants if states opt for the longer certification.
Who is hurt
State governments, which would face a mandate and a 10 percent state share after the first 20 quarters, plus administrative and dental coverage costs and a 5-year bar on tightening pregnancy eligibility. Hospitals that plan to close obstetric units, which would face new notice and reporting duties. Users and sellers of roll-your-own, pipe, and smokeless tobacco, who would pay sharply higher excise taxes, and lower-income users would bear a larger share of that burden. Federal taxpayers, since the bill authorizes and appropriates new spending that would add to costs unless offset. Grant applicants that are not selected.
Supporters argue
Supporters argue the bill targets a measurable problem: the bill's findings state that the U.S. maternal mortality rate is above that of other high-income countries, and CDC data show 53 percent of pregnancy-related deaths occur between 7 days and 1 year after delivery, after Medicaid coverage may lapse at 60 days. They contend that guaranteed 12-month coverage, high federal matching rates, and grants for quality collaboratives and doulas fund approaches that states like California have used to improve outcomes. They add that tobacco tax increases offset part of the cost.
Opponents argue
Opponents argue the bill turns an existing state option into a federal mandate, imposing long-term costs on state budgets once the 100 percent federal match ends, while the new grants and appropriations add federal spending without clear offsets. They contend that several programs, such as implicit bias training centers and doula grants, have limited proof of reducing deaths on the scale claimed, and that the bill's findings state causes, including systemic racism, that remain disputed. They also argue the steep excise tax increases fall on lower-income tobacco users.
Constitutional context
Congress acts under the Taxing and Spending Clause (Art. I, §8, cl. 1) and its excise tax power. The mandate on states to cover postpartum care as a condition of Medicaid funds raises the coercion limit from NFIB v. Sebelius (2012), though the 90 to 100 percent federal match and the fact that postpartum coverage extends an existing program, not a new one as in NFIB, may bear on that analysis.
Checks and balances
The bill expands authority of the Secretary of Health and Human Services to run grant programs and set guidance, and of Congress over state Medicaid conditions; checks include annual appropriations, required reports to Congress, state legislative timing exceptions, and judicial review of spending conditions.
Historical precedent
The American Rescue Plan Act of 2021 created a state option for 12-month postpartum Medicaid coverage, which this bill would make mandatory, and earlier Preventing Maternal Deaths Act legislation funded state maternal mortality review committees.