Sponsors (15)
Official title: Amend the Public Health Service Act to provide for a special enrollment period for pregnant women, and for other purposes.
Introduced November 20, 2025 by Angela Deneece Alsobrooks · Last progress November 20, 2025
The bill expands and standardizes maternity coverage and enrollment rights—improving access and continuity for pregnant and postpartum people—at the cost of higher insurance and public spending, increased administrative burdens, and potential uneven protections across states.
Low-income pregnant and postpartum people on Medicaid/CHIP will get continuous eligibility through pregnancy and 12 months postpartum, reducing churn and improving access to postpartum care.
People covered under family and employer plans (including adult dependents) will have guaranteed coverage for pregnancy, childbirth, postpartum care, and labor & delivery beginning in plan years starting Jan 1, 2027, lowering out-of-pocket costs for childbirth.
Pregnant individuals (including federal employees and eligible family members) will be able to enroll in health plans when pregnancy is reported (special enrollment/qualifying life event) and FEHB processes are protected even during short appropriations lapses, enabling earlier access to prenatal and maternity services.
Insurers, employers, and taxpayers may face higher costs (premiums, claims, or public spending) as a result of expanded pregnancy-related enrollment, guaranteed maternity benefits, and longer Medicaid coverage periods.
States may experience increased Medicaid/CHIP budget pressure from maintaining higher eligibility levels and providing 12-month postpartum coverage, potentially prompting requests for more federal funds or cuts elsewhere.
Plans, Exchanges, federal agencies and insurers will incur additional administrative, IT, and compliance costs to implement new special enrollment periods, benefit mandates, contract changes, and state enabling actions.
Based on analysis of 8 sections of legislative text.
Requires pregnancy special enrollment periods, mandates maternity coverage for dependents, makes 12-month postpartum Medicaid/CHIP coverage permanent, and preserves state pregnancy eligibility floors.
Creates a new federally protected enrollment pathway and coverage requirements to make maternity care and postpartum coverage more accessible and continuous. The bill requires special enrollment periods for pregnant people, mandates that group and dependent coverage include maternity services for all dependents regardless of age, makes 12-month postpartum Medicaid and CHIP coverage permanent, preserves certain state Medicaid pregnancy eligibility levels, and directs OPM to treat pregnancy as a qualifying life event for FEHB enrollment. Many provisions take effect for plan years beginning January 1, 2027 or within one year after enactment for Medicaid/CHIP changes.