H.R. 3365 — HEALTH for MOM Act of 2025

This section establishes a Medicaid state plan option, beginning two years after enactment and after consultation with providers and enrollees, for eligible pregnant women to voluntarily enroll in or receive pregnancy and postpartum coordinated care services from a designated maternity health home (i.e., a provider, team of health care professionals, or health team meeting Secretary-established standards). Eligible women are those receiving full-scope Medicaid benefits (not limited pregnancy-related coverage) who are pregnant, with such eligibility deemed to continue through the earlier of the end of Medicaid eligibility or one year postpartum. The Secretary must set qualification standards for maternity health homes, requiring them to (1) coordinate access to maternity, postpartum, and specialist services; (2) develop individualized, patient-centered care plans accommodating preferences and payment adjustments; (3) incorporate home care, community-based care, inpatient care, social supports, behavioral health, emergency care, and oral health services in a culturally and linguistically appropriate manner; (4) coordinate with pediatric, community, behavioral health, social service, hospital, oral health, specialist, and early intervention providers; and (5) collect and report data. States must pay maternity health homes using a specified methodology—such as per-member per-month, prospective payments for federally qualified health centers or rural health clinics, or an approved alternate—including risk-severity adjustments, with such payments treated as medical assistance and the federal medical assistance percentage increased by 15 percentage points (not to exceed 90%) for the first four fiscal year quarters the option is in effect.