Maternal and Child Health Benefits in the Federal Healthcare Reform Legislation

Written by the Maternity Care Coalition

An initial review of the Patient Protection and Affordable Care Act (PL 111-148) and Health Care and Education Reconciliation Act, reveals the following important elements for Maternal and Child Health: 

  • Breastfeeding:  All employers with 50 or more employees must permit break time for women to breast pump and/or feed their infants.  Effective Immediately.
  • Creates a state based home visiting program to serve higher risk families during pregnancy and the infant-toddler years. States must complete a needs assessment in the next 6 months or by September 2010.
  • Maternal Depression: Provides NIMH funds for support services and education about the impact of emotional wellness on the infant and family. 
  • Changes in Insurance Plans:
    • Insurance companies will not be able to deny coverage for pre-existing conditions such as pregnancy, or prior cesarean section delivery.  Effective in 2014.
    • Insurance companies cannot charge higher premiums based on gender or health status.  Effective in 2014.
    • All Health Plans will need to cover essential health benefits including maternity and newborn care and behavioral health treatment. Effective in 2014.
    • All private insurance plans will be required to offer a package of women’s preventive care and screening (Pap smears and mammograms) without requiring co-pays. Effective Jan 1, 2011.
    • Excludes pre-existing conditions for children immediately.

Wider opportunities for women to have access to care effective during the next 4 years:

  • State grants to promote community health teams’ service support to primary care practices will include obstetricians.
  • Obstetricians will be considered as primary care physicians and could receive increased Medicaid reimbursement, as the primary care physician.  
  • Free standing Birth Centers and their licensed practitioners will be eligible for Medicaid reimbursement within 90 days.
  • Certified Nurse-Midwives will receive equitable reimbursement.
  • Increased funding for the education of all childbirth professionals.

Questions that need to be explored further in Pennsylvania

Current PA laws permit gender rating, the exclusion of pregnancy in insurance benefit plans and considers pregnancy a pre-existing condition.  It is not clear how these state laws and regulations will be reconciled with the federal legislation. 

  • High Risk Pools-States can immediately apply for funds to establish high risk pools for individuals who have been uninsured for the last six months and have pre-existing conditions.  Since PA individual and small group markets consider pregnancy a pre-existing condition and may not insure pregnancy, would this high risk pool include pregnant women?
  • Insurance companies will not be able tocancel a policy if the insured gets sick beginning 2010.  Is pregnancy considered a sickness?

Additional initiatives in the legislation that could impact Maternal and Child Health:

  • Provides funding to states for Health Insurance Ombudsman or Consumer Assistance to educate and help consumers.
  • DHHS establishes a consumer friendly web portal with standard formats for comparing insurance plans. 
  • Defines health disparities and provides incentive payments for activities to reduce the disparities.
  • Provides new funds for school based health programs which provide STI and birth control counseling and services.
  • Establishes the DHHS Coordinating Committee on Women’s Health to coordinate all the Offices on Women’s Health in major federal agencies which codifies the promotion of women’s health.
  • Health Information Technology (HIT) provisions and initiatives


Please send questions, corrections and comments to:
Letty Thall, Maternity Care Coalition, LThall@momobile.org