Healthy MOM Act
Summary
What This Bill Does
The Healthy MOM Act treats pregnancy as a coverage-triggering event across individual, exchange, group, ERISA, tax-code, and Federal employee health benefit rules. Pregnant individuals can receive a special enrollment period when pregnancy is reported or confirmed, with regulations setting enrollment windows and effective dates. OPM must treat pregnancy as a change in family status and qualifying life event for eligible but unenrolled Federal employees and dependents, and FEHB enrollment services tied to the pregnancy event are treated as emergency services during appropriations lapses. The bill preserves State Medicaid income standards for pregnant individuals and infants at no less than the levels in effect as of January 1, 2025, and makes full-benefit Medicaid and CHIP coverage mandatory throughout pregnancy and the 12-month postpartum period rather than optional or ending around 60 days postpartum.
Who Benefits and How
Pregnant individuals benefit from a new chance to enroll in exchange, individual, group, ERISA, and FEHB coverage when pregnancy begins instead of waiting for the next open enrollment period. Medicaid and CHIP pregnant and postpartum enrollees benefit from mandatory full benefits through 12 months after pregnancy. Newborns and families benefit from improved access to maternity, newborn, and postpartum care that can reduce preventable complications.
Who Bears the Burden and How
Health insurers, group health plans, employers, exchanges, OPM, CMS, and State Medicaid and CHIP agencies must update enrollment rules, notices, effective-date systems, income standards, and postpartum-coverage operations. Insurers and public programs may bear higher near-term claims costs from earlier maternity and postpartum coverage. States may need legislation or budget changes to comply with new Medicaid and CHIP requirements.
Key Provisions
- Adds pregnancy as a special enrollment period for individual, exchange, group, tax-code, and ERISA health coverage.
- Requires regulations for pregnancy special-enrollment periods and coverage effective dates beginning with plan years on or after January 1, 2027.
- Directs OPM to treat pregnancy as a FEHB qualifying life event and emergency enrollment service during appropriations lapses.
- Protects Medicaid income eligibility standards for pregnant individuals and infants at no less than January 1, 2025 levels.
- Requires full-benefit Medicaid and CHIP coverage throughout pregnancy and the 12-month postpartum period.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Creates pregnancy special-enrollment rights across health insurance markets and strengthens maternity, Medicaid, CHIP, FEHB, and postpartum coverage protections.
Key Policy Areas
Healthcare, Insurance, Medicaid
Primary Purpose
Creates pregnancy special-enrollment rights across health insurance markets and strengthens maternity, Medicaid, CHIP, FEHB, and postpartum coverage protections.
Policy Domains
Substantive provisions
Identified Gains
- Pregnant individuals seeking health coverage
- Medicaid postpartum enrollees
- CHIP pregnant enrollees
- Federal employees with pregnancy-related enrollment needs
- Newborns
Identified Costs
- Health insurance issuers
- Group health plans
- State Medicaid agencies
- Centers for Medicare and Medicaid Services
- Office of Personnel Management
Sponsors
Legislative Progress
In CommitteeMrs. Watson Coleman (for herself, Ms. Clarke of New York, …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
CHIP pregnant enrollees, Infants eligible for Medicaid, Medicaid postpartum enrollees
Centers for Medicare and Medicaid Services, Federal employees with pregnancy-related enrollment needs, Health insurance exchanges
Positive-direction: Federal employees with pregnancy-related enrollment needs
Negative-direction: Centers for Medicare and Medicaid Services, Health insurance exchanges, Office of Personnel Management
Federal employee health benefit plans, Group health plans, Health insurance issuers
State CHIP agencies, State Medicaid agencies
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology