S-4913-119
Read twice and referred to the Committee on Finance.
Sponsored by Cory Booker (D-NJ)
What it does
The MOMMIES Act would make four major changes to Medicaid and the Children's Health Insurance Program (CHIP). First, it would extend postpartum coverage from 60 days to 12 months (with states allowed to go longer), effective January 1, 2027. Second, it would require states to cover full Medicaid benefits — including mandatory dental/oral health services — during pregnancy and for the full postpartum year. Third, it would restore and expand a Medicare payment rate floor for primary care services under Medicaid, adding OB-GYNs, midwives, and advanced practice clinicians to the list of qualifying providers. Fourth, it would establish a 5-year Maternity Care Home demonstration grant program in at least 10 states, directing the federal government to pay 100% of the additional costs states incur from the new coverage requirements.
Who benefits
Low-income pregnant and postpartum individuals enrolled in Medicaid or CHIP, who would gain up to 10 additional months of continuous coverage. Newborns and infants whose mothers maintain coverage and access to care. Doulas, midwives, certified nurse-midwives, and community health workers who would gain formal recognition and reimbursement pathways under Medicaid. Federally qualified health centers, rural health clinics, and freestanding birth centers that would receive higher primary care payment rates. Dentists and oral health providers who would gain a new mandatory Medicaid patient population. States that opt in to the demonstration project, which would receive 100% federal matching funds for new costs. Racial and ethnic minority communities, particularly Black and Indigenous individuals, who experience disproportionately high maternal mortality rates. Residents of rural and medically underserved areas with limited obstetric access.
Who is hurt
State Medicaid agencies that must implement new eligibility tracking, benefit expansions, and reporting requirements, even with enhanced federal matching. Managed care organizations contracting with Medicaid that would be required to pay higher primary care rates, potentially compressing their margins. Traditional hospital-based OB providers who may face competitive pressure from newly reimbursed birth centers and midwives. Taxpayers broadly, as the bill authorizes open-ended appropriations ("such sums as may be necessary") for the demonstration project through 2034. States that currently provide less than 12 months of postpartum coverage and have not yet expanded under the ACA may face significant administrative and fiscal transition costs before the 100% FMAP kicks in. Private insurers and employer-sponsored plans are not directly regulated but may face indirect cost-shifting pressures if Medicaid absorbs more postpartum care.
Supporters argue
Supporters argue that the United States has the highest maternal mortality rate among high-income nations, and that the current 60-day postpartum coverage window leaves low-income mothers without insurance during the period when most pregnancy-related deaths occur — the CDC reports that over half of maternal deaths happen between one week and one year after delivery. They contend that the 100% federal matching rate eliminates the fiscal barrier that has prevented many states from voluntarily extending coverage, and that the primary care payment floor addresses a well-documented provider shortage in Medicaid by aligning reimbursement rates with Medicare, which research consistently links to greater provider participation and access.
Opponents argue
Opponents argue that the bill's open-ended appropriations authorization and 100% federal matching rate create a long-term federal spending commitment with no defined cost ceiling, and that once states build programs around full federal funding, reducing that commitment becomes politically difficult — a structural dynamic the Supreme Court flagged as a coercion concern in NFIB v. Sebelius (2012). They contend that mandating specific benefit packages, provider types, and payment rates overrides state flexibility that is foundational to the Medicaid partnership model, and that the maintenance-of-effort provisions — which cut off all federal Medicaid funding if states reduce coverage — may themselves approach the kind of coercive conditions the Court found unconstitutional in the Medicaid expansion context.
Constitutional context
Congress exercises authority here under the Taxing and Spending Clause (Art. I, §8, cl. 1) and the Necessary and Proper Clause (Art. I, §8, cl. 18), which together support conditional federal grants to states through Medicaid and CHIP. The maintenance-of-effort provisions — which would cut off all federal Medicaid funding if states reduce coverage — could invite a Spending Clause coercion challenge under NFIB v. Sebelius (2012), which held that conditioning all existing Medicaid funds on acceptance of a major new expansion was unconstitutionally coercive. Post-Loper Bright (2024), any CMS regulations implementing the new benefit mandates or payment floors would face independent judicial review rather than deferential scrutiny.
Checks and balances
Congress gains authority by mandating new Medicaid benefit and payment standards; HHS/CMS implements through regulation and guidance subject to post-Loper Bright independent judicial review; the GAO and MACPAC provide oversight through required reports; states retain some flexibility in setting coverage periods beyond the 12-month floor and in applying for the demonstration project.
Historical precedent
The American Rescue Plan Act of 2021 created a state option (not a mandate) to extend postpartum Medicaid coverage to 12 months; this bill would convert that option into a federal requirement and add benefit and payment mandates not present in the 2021 law.