HR-8907-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Janice Schakowsky (D-IL)
What it does
This bill would direct the Centers for Medicare & Medicaid Services (CMS) to create and run a five-year demonstration project (FY2027–2031) testing alternative payment models for maternity care under Medicaid (Title XIX) and the Children's Health Insurance Program (Title XXI). States would voluntarily apply to participate and test different ways of paying for pregnancy and postpartum care. After the project ends, CMS would be required to report results to Congress and recommend whether the program should be made permanent and expanded nationally.
Who benefits
Pregnant and postpartum Medicaid and CHIP enrollees, particularly those from racial and ethnic minority groups who face higher rates of maternal mortality and severe maternal morbidity. Midwives, doulas, community health workers, lactation consultants, and other non-physician maternity care providers who may gain expanded reimbursement pathways. Freestanding birth centers and federally qualified health centers that could receive payments under new models. States seeking flexibility to redesign maternity care payment. Researchers and public health advocates focused on maternal health disparities. Indirectly, newborns and families who benefit from improved maternal health outcomes.
Who is hurt
States that do not participate would not receive federal support for payment model innovation, potentially widening gaps between states. Traditional fee-for-service maternity care providers — particularly hospital systems — may face reduced payments or increased competition if alternative models shift volume to birth centers or non-physician providers. Insurers and managed care organizations operating under existing Medicaid contracts may face administrative disruption. Taxpayers bear the cost of the demonstration project, though the appropriation is open-ended ("such sums as necessary"). Uninsured pregnant individuals are not covered by this program and would not benefit.
Supporters argue
Supporters argue that the United States has the highest maternal mortality rate among high-income nations, and that Black and Indigenous women die from pregnancy-related causes at two to three times the rate of white women — a disparity that existing fee-for-service payment structures have failed to address. They contend that alternative payment models tied to quality metrics and risk stratification could align financial incentives with better outcomes, and that the voluntary, state-based pilot structure allows evidence to be gathered before any national commitment is made. The bill's explicit focus on social determinants of health, implicit bias training, and diverse care teams directly targets the documented drivers of racial disparities in maternal outcomes.
Opponents argue
Opponents argue that a five-year demonstration project with an open-ended appropriation lacks the fiscal discipline and defined benchmarks needed to ensure accountability, and that CMS already has broad authority under the Center for Medicare and Medicaid Innovation (CMMI) to test payment models without new legislation. They contend that mandating consideration of specific provider types, racial and ethnic diversity criteria, and implicit bias training in payment model design may introduce administrative complexity that burdens states and providers without clear evidence these requirements improve clinical outcomes. Critics may also argue that the bill's "such sums as necessary" funding structure bypasses the normal appropriations process, reducing congressional oversight of actual spending.
Constitutional context
Congress funds Medicaid and CHIP under the Taxing and Spending Clause (Art. I, §8, cl. 1), and states participate voluntarily — a structure the Supreme Court affirmed in NFIB v. Sebelius (2012), which also established that funding conditions cannot be so coercive as to leave states no real choice. Because participation here is entirely voluntary and no existing funding is conditioned on joining, the Spending Clause coercion concern identified in NFIB is unlikely to apply.
Checks and balances
The Executive Branch (HHS/CMS) gains authority to design and administer the demonstration project; Congress retains oversight through the mandatory report and recommendation, and controls ultimate funding through the appropriations process.
Historical precedent
The Center for Medicare and Medicaid Innovation (CMMI), created by the ACA in 2010, has previously tested alternative payment models for maternity care, including the Strong Start for Mothers and Newborns initiative (2012–2016), which tested enhanced prenatal care in birth centers and other settings for high-risk Medicaid enrollees.