HR7227-119

What This Bill Does

The Mental Health and MAMA Act of 2026 applies maternal mental-health cost-sharing protections across the main federal health-plan statutes. If a group health plan or health insurance issuer already covers mental health services or substance use disorder services, including covered telehealth services, the plan or issuer may not impose deductibles, copayments, coinsurance, or other cost sharing for in-network services furnished from the diagnosis of pregnancy through the one-year period after the last day of pregnancy. The protection applies to group and individual coverage under the Public Health Service Act, group plans under ERISA, and group plans under the Internal Revenue Code, with the operative date for plan years beginning two years after enactment. The bill uses the existing mental health and substance use disorder service definitions from parity law and the telehealth definition from PHSA section 330I.

Who Benefits and How

Pregnant enrollees, postpartum enrollees, pregnant workers with employer coverage, postpartum workers with employer coverage, patients using telehealth, mental health providers, substance use disorder providers, and maternal health advocates benefit because in-network counseling, treatment, and telehealth mental-health or substance-use care would be covered without cost sharing during pregnancy and the first postpartum year. Families may benefit if lower out-of-pocket costs make postpartum depression, anxiety, or substance-use treatment easier to access.

Who Bears the Burden and How

Group health plans, health insurance issuers, employer plan sponsors, third-party administrators, plan actuaries, HHS enforcement staff, Labor Department benefits staff, and Treasury benefits staff must update plan designs, claims systems, network rules, notices, enforcement procedures, and pricing for no-cost-sharing maternal mental-health and substance-use services. Premiums or plan costs may rise if plans absorb costs that patients previously paid at the point of care.

Key Provisions

• Bars cost sharing for in-network mental health services during pregnancy and for one year postpartum.
• Bars cost sharing for in-network substance use disorder services during pregnancy and for one year postpartum.
• Includes telehealth services when the plan or coverage provides the underlying covered benefit.
• Applies the protection to group and individual coverage under the Public Health Service Act.
• Adds parallel ERISA and Internal Revenue Code requirements for group health plans.
• Delays application until plan years beginning two years after enactment.