Right now, marriage, divorce, having a baby, adoption, and changing jobs are considered qualifying life events that trigger a special enrollment period. However, becoming pregnant is not considered a qualifying event.
The Healthy Maternal and Obstetric Medicine (Healthy MOM) Act would ensure that all people eligible for coverage through the Affordable Care Act insurance marketplaces, as well as those eligible for other individual or group health plan coverage, can access affordable health coverage throughout their pregnancies by establishing a special enrollment period for expectant mothers.
The Healthy MOM Act will allow pregnant people to sign up for or change their coverage when they become pregnant, rather than needing to wait for the birth of their child or the annual enrollment period. The bill would also guarantee 12 months of postpartum continuous Medicaid coverage, thus removing key barriers that often prevent mothers from getting the care they need after birth.
“To combat our nation’s maternal mortality crisis, we need to ensure more women, particularly women of color, have access to the maternal care they need during and after pregnancy,” said Sen. Tim Kaine, D-VA, a co-sponsor of the bill. “This important legislation would do just that by expanding health care enrollment for expectant mothers and helping ensure they receive affordable coverage after their babies are born.”
According to the Centers for Disease Control and Prevention, about 700 women die each year in the United States from pregnancy-related complications. Black and American Indian/Alaska Native women are about three times more likely to die from a pregnancy-related cause than white women. The Healthy MOM Act will work to improve these outcomes by expanding quality access to care, which data demonstrate could help prevent three in five pregnancy related deaths.
Specifically, the Healthy MOM Act would:
- Create a special enrollment period (SEP) in the ACA marketplaces and other commercial insurance plans for pregnant individuals once pregnancy is reported, so that they can enroll in or change their health care plan; clarifies coverage requirements related to coverage of maternity care for dependent children; creates a pregnancy SEP for federal employees; and codifies a continuation of Medicaid income eligibility for pregnant individuals and children;
- Enable the Director of the Office of Personnel Management to establish a special enrollment period for pregnancy, for those eligible to receive coverage through the Federal Employees Health Benefits Program and clarify that the enrollment shall be available for families even during a lapse in appropriation or government shutdown;
- Ensure comprehensive coverage of maternity care – including labor and delivery – for dependent children covered by group health plans and other forms of employer-sponsored coverage;
- Protect against threats to Medicaid income eligibility and maintain the highest standard of care for low-income pregnant individuals and infants, and
- Requires states to provide 12 months of continuous Medicaid eligibility for postpartum individual.
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