Sponsor
Lisa Blunt Rochester
Senator · D-DE
Senator · D-DE
The bill aims to improve access to comprehensive, equity‑focused maternity care for Medicaid/CHIP enrollees (including mental health and non‑hospital options) but does so with open-ended federal spending, added administrative work, and potential financial risk to providers serving high‑risk patients.
Pregnant and postpartum Medicaid/CHIP enrollees will get more coordinated, outcome-focused maternity care that explicitly includes maternal mental health and substance‑use services and expands non‑hospital birth settings and diverse care teams, improving access and options especially in rural and underserved communities.
States testing models must measure and publicly report outcomes by race, ethnicity, language, income, geography, and insurance, increasing visibility into disparities and enabling targeted equity improvements.
The demonstration authorizes unspecified federal spending (“such sums as are necessary”), creating potential additional costs for taxpayers without a defined budget cap or fiscal limit.
States, providers, and health systems will face administrative and implementation costs and burdens to design, apply for, run alternative payment models, and comply with expanded reporting requirements.
If payment models use risk‑adjusted payments or shift financial risk, providers serving higher‑risk patients could face lower effective reimbursement or financial exposure, which may reduce access for patients with complex needs.
Based on analysis of 2 sections of legislative text.
Authorizes a FY2027–FY2031 CMS demonstration letting states test Medicaid/CHIP alternative payment models for perinatal care and requires HHS evaluation and a congressional report.
Official title: Require the Secretary of Health and Human Services to establish a demonstration project to allow States to test payment models for maternity care provided to pregnant and postpartum individuals under the Medicaid and CHIP programs, and for other purposes.
Introduced May 11, 2026 by Lisa Blunt Rochester · Last progress May 11, 2026
Creates a federal demonstration at HHS (CMS) from FY2027–FY2031 that lets states test alternative payment models in Medicaid and CHIP for pregnancy through one year postpartum care. The project requires state applications, stakeholder coordination, specified model features (risk stratification, quality metrics, non-hospital care, social determinants, maternal mental health and SUD), and a formal HHS evaluation with a congressional report and recommendations; funding is authorized as "such sums as are necessary."