Sponsors (20)
Introduced November 20, 2025 by Bonnie Watson Coleman · Last progress November 20, 2025
The bill expands and standardizes pregnancy, maternity, and postpartum coverage—improving timely access and reducing maternal and infant health risks—while imposing higher costs and administrative burdens on insurers, employers, and state/federal budgets that may raise premiums or require trade-offs in other services.
Pregnant people on Medicaid (and their newborns) will have continuous Medicaid coverage for 12 months postpartum, reducing gaps in care after childbirth.
People who are pregnant (including dependents of any age) gain guaranteed coverage for pregnancy, childbirth, and postpartum care in group and individual plans beginning in 2027, ensuring those services are covered by insurers and employer plans.
Pregnancy-triggered special enrollment (immediate enrollment when pregnancy is reported) lets people enroll mid-year in Exchanges and many plans, increasing timely access to prenatal care without waiting for open enrollment.
Insurers, employers, and ultimately enrollees and taxpayers may face higher premiums or costs as mandated maternity and postpartum coverage and mid-year enrollments increase near-term claims and plan expenses.
States will face added fiscal pressure (higher Medicaid spending) to fund extended postpartum coverage and to maintain 2025 eligibility floors, potentially forcing budget trade-offs or higher state expenditures.
Plans, employers, FEHB/OPM, and states will incur administrative and compliance costs to change systems, update processes, and implement regulatory requirements, creating one-time and ongoing burdens.
Based on analysis of 8 sections of legislative text.
Requires health plans, Exchanges, and group coverage to let people enroll when they report a pregnancy and mandates coverage of maternity care for dependents. Locks in state Medicaid income eligibility floors for pregnant people, makes 12-month postpartum Medicaid and CHIP coverage permanent, and directs OPM to treat pregnancy as a qualifying life event for federal employee health benefits. The bill changes multiple federal laws so private insurers, employer plans, Exchanges, Medicaid, and CHIP must offer earlier special enrollment and broader pregnancy and postpartum coverage. Key effective dates include plan-year rules starting Jan 1, 2027 and a one-year post-enactment start for expanded Medicaid/CHIP postpartum benefits.