Keeping Obstetrics Local Act
Sponsored By: Representative Bonamici
Introduced
Summary
This bill would aim to __stabilize local labor and delivery services__ by boosting Medicaid payment rates, creating recurring 'anchor' payments for low-volume hospitals, and expanding coverage and workforce supports for pregnant and postpartum people.
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- Families and pregnant individuals: It would create a Medicaid option for maternity health homes that coordinate care through pregnancy and for 12 months postpartum. The option comes with an initial enhanced Federal Medical Assistance Percentage of 90% for the first eight fiscal quarters and requires mandatory presumptive eligibility for pregnant people.
- Rural and low-volume hospitals: States would have to study maternity care costs and pay eligible hospitals a minimum Medicaid rate starting in FY2027 equal to 150% of the Medicare rate. The bill would also require so-called anchor payments and offers a 100% federal match for the portion of payments that brings hospitals up to the minimum rate.
- Workforce and access: The Secretary could detail Commissioned Corps personnel to areas with urgent maternal needs and the bill authorizes $150 million for these deployments each year. It also streamlines enrollment of nearby out-of-State maternity providers and directs guidance on doula and midwife coverage.
*It would increase federal spending by funding planning and technical grants, authorizing ongoing emergency workforce funding, and expanding federal Medicaid matching for higher maternity payments.*
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 8 benefits, 0 costs, 0 mixed.
12-month postpartum Medicaid and quick prenatal coverage
This bill would require States to give full Medicaid coverage during pregnancy and for 12 months after it ends. The same rule would apply to CHIP. It would also require short-term, presumptive Medicaid so pregnant people can get prenatal care right away, and hospitals could help make quick eligibility decisions. The default start would be the first day of the first calendar quarter that begins one year after enactment, but a State could choose an earlier date or take longer if State law changes are needed.
Federal teams to fill maternity care gaps
HHS could send Commissioned Corps health staff to areas where a hospital closed, is about to close, or lost key maternal health workers. The Secretary could require the local entity to keep services going, submit hiring and transition plans, and allow workplace reviews. Service by detailed staff would count for their pay and benefits. The bill would authorize $150 million each year starting in FY2027 to strengthen and deploy this workforce.
180-day notice before OB unit closes
Hospitals would need to give at least 180 days’ notice before closing an obstetric unit, starting 180 days after this rule takes effect. The notice would have to explain expected community impacts, causes, historic transportation costs, and where patients can get care. States would have to post the hospital’s report online.
Easier enrollment for out-of-state maternity providers
Starting January 1, 2028, States would have to let eligible out-of-state maternity providers enroll in Medicaid or CHIP without extra screening beyond in-state rules. Enrollment would last five years and could be renewed. Providers must be in a neighboring State, have been properly screened, and not be excluded from Medicare or Medicaid. HHS would issue best-practice guidance by January 1, 2028, and the law would update related screening-and-enrollment references.
Higher Medicaid pay for maternity care
Starting in FY2027, Medicaid would have to pay eligible hospitals at least 150% of the Medicare rate for maternity, labor, and delivery services. The Secretary would define which services count and which hospitals qualify by July 1, 2026, and managed care and CHIP would follow these rules. For quarters on or after October 1, 2026, the federal government would pay 100% of the extra cost above a State’s base rate, and certain territorial payments would not count against federal caps. These higher maternity payments would also be ignored when calculating other federal supplemental payment limits, so they would not reduce other support.
Optional maternity health homes in Medicaid
Starting January 1, 2028, States could offer a maternity health home for pregnant people and those up to 12 months after pregnancy who have full Medicaid. The federal share would be 90% for the first eight fiscal quarters. The bill would provide $50 million in FY2027 for State planning grants. Providers and States would have to report enrollment, quality, and maternal mortality data, and States would have to protect patient privacy.
Stability payments for small OB hospitals
States would have to set up an annual "anchor" payment for low-volume obstetric hospitals. By October 1, 2026, States would file a plan; payments would start in FY2028 and be paid within three months after year-end. For FY2028, the revenue floor would be $10,000 per delivery plus $1,200,000 for standby capacity, indexed each year. Hospitals would need to keep up training, sign a contract to keep delivery services for that year and two more, and use the money on labor and delivery or risk repayment.
State maternity cost studies and national report
States would have to study the costs of maternity, labor, and delivery care within 24 months and then every five years. HHS would get $10 million in FY2026 to help small rural hospitals gather data. HHS would publish each State’s results within 12 months of submission and issue a national analysis with recommendations within three years of enactment. HHS would get $3 million in FY2026 for these reports.
Sponsors & CoSponsors
Sponsor
Bonamici
OR • D
Cosponsors
Kelly (IL)
IL • D
Sponsored 6/12/2025
Roll Call Votes
No roll call votes available for this bill.
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