H.R. 6242: Healthy Maternity and Obstetric Medicine Act

This bill, titled the Healthy Maternity and Obstetric Medicine Act, aims to improve access to maternity care for pregnant women in the United States by making several specific changes to current healthcare laws.

Special Enrollment Period for Pregnant Women

The bill introduces a special enrollment period for women who become pregnant. This means that when a woman reports her pregnancy to her health insurance, she can enroll in a healthcare plan outside the usual enrollment period. This policy applies to both group health plans and individual health plans, ensuring that women can obtain coverage as soon as they confirm their pregnancy.

Coverage for Dependent Pregnant Individuals

It mandates that group health plans and individual health plans must provide maternity care coverage for pregnant dependents, including children of any age. This requirement ensures that all pregnant dependents have access to services related to pregnancy, childbirth, and postpartum care.

Medicaid and CHIP Provisions

The bill addresses Medicaid and the Children's Health Insurance Program (CHIP) to guarantee that coverage for pregnant individuals extends for 12 months postpartum. This aims to enhance the health of mothers and newborns by ensuring that women receive continuous care after giving birth.

Furthermore, it maintains existing income eligibility standards for pregnant individuals and infants in these programs, particularly ensuring that the percentage eligibility for Medicaid remains consistent in coming years.

Federal Employee Health Benefit Plans

The bill requires that pregnancy be considered a qualifying life event for federal employees, allowing them to enroll in health benefit plans when they become pregnant. This provision ensures federal employees have access to necessary health coverage during pregnancy.

Impact on Maternal Health Outcomes

By facilitating access to maternity care, the bill aims to improve overall health outcomes for mothers and infants. It recognizes that timely access to maternity care can prevent complications that may arise during pregnancy and childbirth, potentially reducing the incidence of maternal mortality, particularly in communities of color where disparities in maternal health outcomes are significant.

Effective Dates

The changes proposed in the bill will apply to plan years starting on or after January 1, 2027. This gives health plans time to adjust and implement these new requirements.

Relationship to Other Laws

The bill clarifies that it does not invalidate or alter the protections already afforded by existing federal or state laws regarding health plan enrollees. Instead, it seeks to enhance the coverage and protections available to pregnant individuals under current frameworks.

Relevant Companies

• UNH (UnitedHealth Group) - A major health insurer that would need to update plans to comply with the requirements for special enrollment periods and maternity coverage.
• ANTM (Anthem, Inc.) - As a health insurance provider, Anthem would be affected by the need to provide maternity benefits and potentially adjust their offerings for federal employees.
• CNC (Centene Corporation) - This company, which focuses on government-sponsored healthcare programs, could see operational changes as it implements the extended Medicaid postpartum coverage.
• HUM (Humana Inc.) - Similar to other health insurers, Humana will likely need to change its policies regarding maternity care coverage and enrollment regulations.