[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4304 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 4304
To amend title XIX of the Social Security Act to provide coverage under
the Medicaid program for services provided by doulas and midwives, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 9, 2024
Ms. Warren (for herself, Mr. Booker, Mr. Casey, Mr. Padilla, Ms.
Duckworth, Mr. Sanders, Mr. Heinrich, and Mr. Blumenthal) introduced
the following bill; which was read twice and referred to the Committee
on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide coverage under
the Medicaid program for services provided by doulas and midwives, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mamas First Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) According to the Centers for Disease Control and
Prevention, the maternal mortality rate varies drastically for
women by race and ethnicity. On average, there are 26.6 deaths
per 100,000 live births for White women, 69.9 deaths per
100,000 live births for Black women, 49.2 deaths for American
Indian and Alaskan Native women, and 28 deaths per 100,000 live
births for Hispanic women. While maternal mortality disparately
impacts Black women and indigenous women, this urgent public
health crisis traverses race, ethnicity, socioeconomic status,
educational background, and geography.
(2) United States maternal mortality rates are the highest
in the developed world and are increasing rapidly.
(3) Four out of five of these maternal deaths are likely
preventable.
(4) According to the National Institutes of Health, doula-
assisted mothers are four times less likely to have a low-
birth-weight baby, two times less likely to experience a birth
complication involving themselves or their baby, and
significantly more likely to initiate breastfeeding.
(5) Midwife-led care is associated with cost savings,
decreased rates of intervention, lower cesarean rates, lower
preterm birth rates, and healthier outcomes for mothers and
babies.
(6) Midwives may practice in any setting, including the
home, community, hospitals, birth centers, clinics, or health
units.
SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY DOULAS AND MIDWIVES.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)--
(A) in paragraph (31), by striking ``and'' at the
end;
(B) by redesignating paragraph (32) as paragraph
(33); and
(C) by inserting after paragraph (31) the following
new paragraph:
``(32) services and care, including prenatal, delivery, and
postpartum care, that is provided in a culturally congruent
manner by doulas, midwives, and tribal midwives (as those terms
are defined in subsection (kk)), that is provided in the home,
community, a hospital, birth center, clinic, health unit, or is
furnished via telehealth to the extent authorized under State
law; and''; and
(2) by adding at the end the following:
``(kk) Doulas, Midwives, and Tribal Midwife Defined.--For purposes
of subsection (a)(32):
``(1) Doulas defined.--The term `doula' means an individual
who--
``(A)(i) has completed 60 hours of foundational
training;
``(ii) is certified by an organization, which has
been established for not less than five years and which
requires the completion of continuing education to
maintain such certification, to provide non-medical
advice, information, emotional support, and physical
comfort to an individual during such individual's
pregnancy, childbirth, and postpartum period; and
``(iii) maintains such certification by completing
such required continuing education;
``(B) has received three letters of recommendation
from former clients in the past 5 years; or
``(C) is already authorized to serve within the
individual's State.
``(2) Midwives defined.--The term `midwife' means a midwife
who meets at a minimum the international definition of the
midwife and global standards for midwifery education as
established by the International Confederation of Midwives.
``(3) Tribal midwife defined.--The term `tribal midwife'
means an individual who is recognized by an Indian tribe (as
defined in section 4 of the Indian Health Care Improvement Act
(25 U.S.C. 1603)) to practice midwifery for such tribe.''.
(b) Requiring Mandatory Coverage Under State Plan.--Section
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A))
is amended, in the matter preceding clause (i), by striking ``and
(30)'' and inserting ``(30), and (32)''.
(c) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to medical
assistance furnished on or after January 1, 2024.
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) that the Secretary of Health and Human
Services determines requires State legislation in order for the
respective plan to meet any requirement imposed by amendments
made by this section, the respective plan shall not be regarded
as failing to comply with the requirements of such title solely
on the basis of its failure to meet such an additional
requirement before the first day of the first calendar quarter
beginning after the close of the first regular session of the
State legislature that begins after the date of the enactment
of this Act. For purposes of the previous sentence, in the case
of a State that has a 2-year legislative session, each year of
the session shall be considered to be a separate regular
session of the State legislature.
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