Healthy MOM Act Mandates 12-Month Postpartum Coverage and Creates Instant Enrollment for Pregnant Individuals

The Healthy Maternity and Obstetric Medicine Act, or the Healthy MOM Act, is a comprehensive bill designed to expand and secure health insurance coverage for pregnant individuals and newborns. The core of the bill is simple: if you’re pregnant, you should be able to get health coverage immediately, and that coverage should stick around long enough to cover critical postpartum care. Key provisions include creating special enrollment periods across all major insurance markets, requiring dependent coverage to include maternity care regardless of age, and permanently mandating 12 months of continuous Medicaid and CHIP coverage after delivery.

The 'I'm Pregnant Now' Enrollment Window

One of the biggest hurdles for people who find out they are pregnant is getting timely insurance access. Right now, you usually have to wait for open enrollment or a specific qualifying life event, which can mean weeks or months without vital prenatal care. Section 3 of this Act changes that, creating a Special Enrollment Period (SEP) across the board. If you report your pregnancy to the health insurance exchange, the individual market, or your employer’s group health plan, you trigger an immediate enrollment opportunity. This means no more waiting for the next open enrollment period to get covered for prenatal visits. For employer plans, the Secretary will need to issue regulations to establish the exact timeline for enrollment and when coverage becomes effective, but the intent is clearly to make coverage available right away.

Closing the Dependent Coverage Gap

If you have a young adult dependent—say, a daughter still covered under your family plan—and she becomes pregnant, her coverage might not include maternity care. Section 4 directly addresses this gap. It mandates that any group health plan offering dependent coverage must now include coverage for all maternity care, including labor, delivery, and postpartum services, for those dependents. This coverage is required regardless of the dependent’s age, which is a significant protection for young adults who rely on their parents' plans.

Medicaid and CHIP: A Full Year of Postpartum Protection

For low-income families relying on Medicaid and CHIP, coverage often ends 60 days after birth, despite data showing many maternal deaths occur much later. Section 7 makes the current optional 12-month continuous coverage for pregnant and postpartum individuals mandatory and permanent for all states. This means that once this provision takes effect, if you qualify for Medicaid or CHIP during pregnancy, you are guaranteed coverage for a full year after delivery. This is a huge win for stabilizing health outcomes during the critical postpartum period. Furthermore, Section 6 sets a permanent floor for Medicaid income eligibility for pregnant individuals and infants, ensuring states can’t drop their eligibility standards below the level they had set in early 2025.

What it Means for Federal Employees and the Cost of Doing Business

For federal workers, Section 5 ensures that pregnancy is officially recognized as a “qualifying life event” under the Federal Employees Health Benefits Program (FEHBP), allowing eligible employees to enroll or change plans outside the normal enrollment window. In a nod to the realities of government shutdowns, the bill also designates the services needed to enroll pregnant individuals as “excepted services.” This means those enrollment services can continue even during a government funding lapse, ensuring new parents don't lose access to coverage because of political gridlock.

While this bill promises major benefits for maternal and infant health, it does put new requirements on health insurance issuers and employer group health plans, which will have to adjust their systems to accommodate the new immediate enrollment windows and the required dependent maternity coverage. States, too, will be required to fund the full 12 months of continuous Medicaid coverage, which could represent an increased cost burden, though the long-term savings from improved health outcomes are projected to offset some of this.