Enhancing Medicaid and CHIP benefits for low-income pregnant individuals

(a) Extending continuous Medicaid and CHIP coverage for pregnant and postpartum individuals (1) Medicaid Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended— (A) in section 1902(e)— (i) in paragraph (6), by striking 60-day period (beginning on the last day of her pregnancy) and inserting 1-year period beginning on the last day of the pregnancy (or such longer period beginning on such day as the State may elect); and (ii) by striking paragraph (16); (B) in section 1902(l)(1)(A), by striking 60-day period beginning on the last day of the pregnancy and inserting 1-year period beginning on the last day of the pregnancy or such longer period beginning on such day as the State may elect; (C) in section 1903(v)(4)(A)(i), by striking 60-day period beginning on the last day of the pregnancy and inserting 1-year period beginning on the last day of the pregnancy or such longer period beginning on such day as the State may elect; and (D) in section 1905(a), in the 4th sentence in the matter following the last numbered paragraph of such section, by striking 60-day period beginning on the last day of her pregnancy and inserting 1-year period beginning on the last day of the pregnancy, or such longer period beginning on such day as the State may elect. (2) CHIP Section 2112 of the Social Security Act (42 U.S.C. 1397ll) is amended— (A) in subsection (d)(2)(A), by striking 60-day period and all that follows through the semicolon and inserting 1-year period beginning on the last day of the pregnancy, or such longer period beginning on such day as the State may elect, ends;; and (B) in subsection (f)(2), by striking 60-day period (beginning on the last day of the pregnancy) and inserting 1-year period beginning on the last day of the pregnancy, or such longer period beginning on such day as the State may elect,. (b) Requiring full benefits for pregnant and postpartum individuals (1) In general Paragraph (5) of section 1902(e) of the Social Security Act (24 U.S.C. 1396a(e)) is amended to read as follows: (5) Coverage of full benefits for at least 1 year for pregnant and postpartum individuals (A) In general Any individual who, while pregnant, is eligible for and has received medical assistance under the State plan approved under this title or a waiver of such plan (including during a period of retroactive eligibility under subsection (a)(34)) shall continue to be eligible under the plan or waiver for medical assistance through the end of the month in which the 1-year period beginning on the last day of the pregnancy, or such longer period beginning on such day as the State may elect, ends, regardless of the basis for the individual's eligibility for medical assistance, including if the individual's eligibility for medical assistance is on the basis of being pregnant. (B) Scope of benefits The medical assistance provided for a pregnant or postpartum individual described in subparagraph (A) shall— (i) include all items and services covered under the State plan (or waiver) that are not less in amount, duration, or scope, or are determined by the Secretary to be substantially equivalent, to the medical assistance available for an individual described in subsection (a)(10)(A)(i); and (ii) be provided for the individual while pregnant and during the 1-year period that begins on the last day of the pregnancy, or such longer period beginning on such day as the State may elect, and ends on the last day of the month in which such period ends.. (2) Conforming amendments (A) Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph (G) by striking (VII) the medical assistance and all that follows through during the period described in such section,. (B) Section 2107(e)(1)(K) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(J)) is amended— (i) by striking Paragraphs (5) and (16) and inserting Paragraph (5); and (ii) by striking (relating to and all that follows through the period and inserting (relating to the provision of medical assistance to pregnant individuals during and following pregnancy under title XIX).. (c) Requiring coverage of oral health services for pregnant and postpartum individuals (1) Medicaid Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (A) in subsection (a)(4)— (i) by striking; and (D) and inserting; (D); (ii) by striking; and (E) and inserting; (E); (iii) by striking; and (F) and inserting; (F); and (iv) by inserting; and (G) oral health services for pregnant and postpartum individuals (as defined in subsection (ll)) after (or waiver of such plan); and (B) by adding at the end the following new subsection: (ll) Oral health services for pregnant and postpartum individuals (1) In general For purposes of this title, the term oral health services for pregnant and postpartum individuals means dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions that are furnished to an individual during pregnancy (or during the 1 year period that begins on the last day of the pregnancy, or such longer period beginning on such day as the State may elect). (2) Coverage requirements To satisfy the requirement to provide oral health services for pregnant and postpartum individuals, a State shall, at a minimum, provide coverage for preventive, diagnostic, periodontal, and restorative care consistent with recommendations for comprehensive perinatal oral health services and dental services during pregnancy from the American Academy of Pediatric Dentistry and the American College of Obstetricians and Gynecologists.. (2) CHIP Section 2103(c)(6)(A) of the Social Security Act (42 U.S.C. 1397cc(c)(6)(A)) is amended by inserting or a targeted low-income pregnant individual after targeted low-income child. (3) Technical amendment Section 2112(d)(2) of the Social Security Act (42 U.S.C. 1397ll(d)(2)) is amended— (A) in the paragraph header, by inserting; targeted low-income pregnant individual after woman; and (B) by striking the term targeted low-income pregnant woman means and inserting the terms targeted low-income pregnant woman and targeted low-income pregnant individual mean. (d) Maintenance of effort (1) Medicaid Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended— (A) in subsection (a)(74), by striking subsection (gg); and and inserting subsections (gg) and (zz);; and (B) by adding at the end the following new subsection: (zz) Maintenance of effort related to low-Income pregnant individuals For calendar quarters beginning on or after the date of enactment of this subsection, and before January 1, 2027, no Federal payment shall be made to a State under section 1903(a) for amounts expended under a State plan under this title or a waiver of such plan if the State— (1) has in effect under such plan eligibility standards, methodologies, or procedures (including any enrollment cap or other numerical limitation on enrollment, any waiting list, any procedures designed to delay the consideration of applications for enrollment, any income counting rules, or similar limitation with respect to enrollment) for individuals described in subsection (l)(1) who are eligible for medical assistance under the State plan or waiver under subsection (a)(10)(A)(ii)(IX) that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, for such individuals under such plan or waiver that are in effect on the date of the enactment of the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act; or (2) reduces the amount, duration, or scope of medical assistance available to individuals described in subsection (l)(1) who are eligible for medical assistance under such plan or waiver under subsection (a)(10)(A)(ii)(IX) from what the State provided to such individuals under such plan or waiver on the date of the enactment of the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act.. (2) CHIP Section 2112 of the Social Security Act (42 U.S.C. 1397ll), as amended by subsection (a), is further amended by adding at the end the following subsection: (g) Maintenance of effort For calendar quarters beginning on or after January 1, 2027, and before January 1, 2031, no payment may be made under section 2105(a) with respect to a State child health plan if the State— (1) has in effect under such plan eligibility standards, methodologies, or procedures (including any enrollment cap or other numerical limitation on enrollment, any waiting list, any procedures designed to delay the consideration of applications for enrollment, or similar limitation with respect to enrollment) for targeted low-income pregnant individuals that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan that are in effect on the date of the enactment of the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act; or (2) provides pregnancy-related assistance to targeted low-income pregnant individuals under such plan at a level that is less than the level at which the State provides such assistance to such individuals under such plan on the date of the enactment of the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act.. (e) Enhanced FMAP Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by subsection (c), is further amended— (1) in subsection (b), by striking and (ii) and inserting (ii), and (mm); and (2) by adding at the end the following new subsection: (mm) Increased FMAP for additional expenditures for low-Income pregnant individuals For calendar quarters beginning on or after January 1, 2027, notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to the additional amounts expended by such State for medical assistance under the State plan under this title or a waiver of such plan that are attributable to requirements imposed by the amendments made by the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act (as determined by the Secretary), shall be equal to 100 percent.. (f) GAO study and report (1) In general Not later than 1-year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the gaps in coverage for— (A) pregnant individuals under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children's Health Insurance Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); (B) postpartum individuals under the Medicaid program and the Children's Health Insurance Program who received assistance under either such program during their pregnancy; and (C) birthing people between the ages of 15 and 49 under the Medicaid program. (2) Content of report The report required under this subsection shall include the following: (A) Information about the abilities and successes of State Medicaid agencies in determining whether pregnant and postpartum individuals are eligible under another insurance affordability program, and in transitioning any such individuals who are so eligible to coverage under such a program at the end of their period of eligibility for medical assistance, pursuant to section 435.1200 of the title 42, Code of Federal Regulations (as in effect on September 1, 2018). (B) Information on factors contributing to gaps in coverage that disproportionately impact underserved populations, including low-income individuals, Black, Indigenous, and other individuals of color, individuals who reside in a health professional shortage area (as defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals who are members of a medically underserved population (as defined by section 330(b)(3) of such Act (42 U.S.C. 254b(b)(3)(A))). (C) Recommendations for addressing and reducing such gaps in coverage. (D) Such other information as the Comptroller General deems necessary. (3) Data disaggregation To the greatest extent possible, the Comptroller General shall dissagregate data presented in the report, including by age, gender identity, race, ethnicity, income level, and other demographic factors. (g) Effective date The amendments made by subsections (a) and (b) shall take effect on January 1, 2027.