The U.S. has the highest maternal mortality rate of high-income countries and over 80% of maternal deaths are preventable. To improve maternal health outcomes, the Black Maternal Health Momnibus Act was introduced in the 117th and 118th by Representative Alma Adams and Representative Lauren Underwood, and Senator Cory Booker. The Momnibus Act is a set of 13 bills that are designed to work together improve maternal health outcomes through a multi-pronged approach. While the Black Maternal Health Momnibus Act has not been reintroduced in the 119th Congress, state legislators have been introducing their own “Momnibus” bills or other legislation related to maternal health.
Following the new state option passed by Congress in 2021, many state legislative proposals included extension of Medicaid postpartum coverage from 60 days to full year. But the bills have also made other improvements in Medicaid such as adding doulas and community health workers as qualified Medicaid providers. Cuts to Medicaid would undermine the work that states are doing to improve maternal health.
California and Delaware passed their own “Momnibus” packages in 2021 and 2022 to not only extend postpartum coverage to 12 months, but to also boost financial and health benefits to pregnant women and their families, along with dedicated initiatives to expand access to community based doulas, require more targeted training for health care providers, and affirm the rights of pregnant people.
And of course, beyond more comprehensive Momnibus bills in the past few years, a grand total of 23 states (AZ, CA, CO, FL, IL, KS, MA, MD, MI, MN, MO, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SD, VA, and WA) and Washington D.C. have adopted legislation that provides for Medicaid financing of doula care.
But despite federal uncertainty around Medicaid, the Momnibus momentum hasn’t stalled much in more recent years—state legislatures are still passing or considering maternal health packages – many with bipartisan support.
In Virginia, Governor Youngkin signed several maternal health bills into law in March designed to strengthen implicit bias training for providers; establish a pathway for midwives to run private practices; allow midwives and nurse practitioners to be on 24-hour-call duty; and require hospitals and birthing facilities to establish obstetric emergency protocols. Another bill that was signed into law ensures that no low-income pregnant women above Medicaid eligibility is barred from accessing available marketplace coverage by establishing special enrollment period for qualified pregnant people on the state-based marketplace. (Birth, not pregnancy, qualifies for special enrollment periods in the federal marketplace. Several state-based marketplaces have opted to also add a special enrollment period for pregnancy.)
Many legislatures are still in session and some have comprehensive maternal health packages still pending this year.
Michigan lawmakers reintroduced a Momnibus package this year that was passed by the Michigan Senate last month, and is now under review House of Representatives. Highlights from Michigan Momnibus package include: requiring the state Department of Health and Human Services (DHHS) to include studies and reports on biased or unjust perinatal care on its website and create a tool for patients to self-report experiences of obstetric racism. It would also require hospitals to have policies that support patient protections, including the ability for patients to bring their doula, spouse, or other companion into the hospital room during labor. The bills would enable collection of information on medical malpractice insurers’ policies related to perinatal care, ensure pregnancy status does not affect the right for a designated patient advocate to make life-sustaining treatment decisions, and affirms the rights of employees to pregnancy or lactation status in public places and in the workplace under sex discrimination law.
The Michigan Momnibus package would also support insurance coverage and workforce for pregnancy and postpartum care by increasing the supply of and access to maternity care and birth services by: adding licensed midwives and midwifery programs to the Michigan Essential Health Provider Repayment program, which pays student loans for providers serving under-resourced areas; requiring private insurers to reimburse licensed midwives services; expanding Medicaid coverage for perinatal and gynecological services by a qualified physician, nurse midwife, or midwife in a hospital or a patient’s home; and requiring Medicaid coverage for off-site or remote ultrasound procedures and fetal nonstress tests.
In Oregon, 72% of pregnancy-related deaths are preventable. State Senator Lisa Reynolds introduced multiple pieces of maternal health legislation. The 2025 version of the Momnibus package focuses on health-related social needs such as housing and income, specifically to: prioritize pregnant people and families with babies for rental assistance, eviction protection, and emergency housing assistance and increase the supply of family-sized affordable housing units. The Momnibus package also seeks to expand the Oregon child tax credit to provide additional direct assistance to families with young families. In the area of health access, the package would: expand the availability of integrated maternal substance use and mental health treatments using evidence-based interventions; increase trainings and financial incentives for community-based care providers, including doulas, lactation counselors, community health workers, and peer support specialists; and align Coordinated Care Organizations, Oregon’s managed-care-like entities, with the upstream, prevention goals of Momnibus 2025. Some of bills have just been introduced and others have had hearings.
New Hampshire’s legislature is considering a Momnibus 2.0 bill that would: provide maternal depression screening for new mothers; provide a perinatal psychiatric provider consultation phone line; increase access to health care services for new mothers; support freestanding birth centers, use family leave for new parents to attend infant pediatric medical appointments; expand access to home visiting, and develop a plan for perinatal peer support certification. Sen. Denise Ricciardi, the bill’s prime sponsor and a Bedford NH Republican, said: “Supporting our moms and families is a shared value across the state and across party lines.”
North Carolina’s MOMnibus 3.0 Act, introduced in April 2025, would: establish a Maternal Care Access Grant Program to fund community-based organizations; establish an implicit bias training program for health care professionals who work in perinatal care; define the rights of patients in perinatal care facilities (e.g., hospitals, clinics, birthing centers); support and diversify lactation consultant training programs. In addition, the bill would establish the MOMNI-BUS Initiative with $6.5 million to provide grants fund efforts to expand access to maternal and infant health care and parenting programs, supports, and services for families residing in geographic areas of the state where there is limited or no access to maternity care services (including prenatal, birth, and postpartum).
Pennsylvania’s Momnibus proposal aims to reduce Black maternal mortality and morbidity. Medicaid coverage for doula services was signed into law by Governor Josh Shapiro on October 29, 2024. Pending legislation includes bills to establish a Doula Advisory Board, require private health insurers to cover doula services, adds Medicaid coverage for blood pressure monitors for pregnant and postpartum women, enhance access to mental health care, require health-related boards to complete implicit bias training, and establish Maternal and Newborn Safety Kit program to distribute essential resources to new moms and parents.
These are only a few examples of states considering maternal health legislation in this session. But while state lawmakers are looking for solutions to combat the maternal health crisis that still persists, Congress is actively working to undermine these efforts. Massive cuts to Medicaid would make millions more Americans become uninsured—many of them pregnant or postpartum women. These cuts also target states’ ability to fully maintain the Medicaid expansion, which ensures more women have access to coverage before they get pregnant. These women of child-bearing age can get their health needs met that lead to healthier pregnancies and births—especially in rural areas. Medicaid cuts could increase maternal mortality rates as well, so why would Congress make it harder for states to improve maternal and infant health outcomes?