Our country is in the throes of a Black maternal mortality epidemic. Black birthing people are three to four times more likely to die from pregnancy complications than their white counterparts. Over the past year, the COVID-19 pandemic has created new and worsened existing barriers to health care and other health-related social needs, exacerbating the Black maternal health epidemic.
Earlier this month, we wrote about the crucial need for Black-led activism, community-building, and community-driven federal legislative solutions such as the Black Maternal Health Momnibus Act (“federal Momnibus”) to promote Black maternal health equity and reproductive justice. Advocates are advancing state “Momnibus” bills in tandem with the federal legislation. Together, these legislative proposals have the potential to help unroot some of the racial injustices driving our Black maternal mortality epidemic. This blog post provides a brief review of the federal Momnibus and explores state approaches.
Review: The Federal Black Maternal Health Momnibus Act
Earlier this year, the Black Maternal Health Caucus reintroduced the Black Maternal Health Momnibus Act (Momnibus). The Momibus is a package of 12 bills designed with, by, and for Black women and birthing people to comprehensively address gaps in policy solutions to the Black maternal mortality epidemic. The legislation addresses some of the root causes of the epidemic by:
- making critical investments in social determinants of health, such as housing, transportation, and initiatives to reduce levels of and exposure to climate change-related risks for birthing people and babies;
- providing funding to community-based organizations working to improve maternal health outcomes and equity;
- promoting access to quality pregnancy-related health care by growing and diversifying the perinatal workforce and creating protections for culturally and linguistically appropriate health care;
- improving data collection and quality measures to further examine the maternal health crisis and inform solutions;
- investing in maternal mental and behavioral health services;
- advancing payment models to incentivize continuity of postpartum health coverage and high-quality maternal health care;
- promoting maternal vaccinations and investing in federal programs to address pregnancy-related risks for COVID-19;
- strengthening maternal health care and support for pregnant and postpartum veterans and incarcerated birthing people; and
- leveraging digital tools such as telehealth to promote maternal health equity in underserved communities.
State Momnibus Bills
Several states have introduced bills that mirror the federal Momnibus this year. Notably, California, Illinois, and North Carolina have introduced omnibus bills that reflect provisions included in the federal Momnibus.
California’s Momnibus, SB 65, which NHeLP co-sponsors, is an innovative piece of legislation that re-imagines maternal health for all Californians. Its goal is to close the racial and socioeconomic maternal health inequities in California. The legislative proposal would increase access to midwifery training programs and incentivize providers to practice in underserved communities. It would also provide full-spectrum doula care to all pregnant and postpartum Medicaid enrollees, and extend Medicaid coverage to one year postpartum. Notably, the California bill would address socioeconomic inequities more directly than the federal Momnibus by providing a guaranteed minimum income for pregnant people at or below 300% of the Federal Poverty Level and improving the CalWORKS program to provide increased pregnancy supplemental income and emergency housing assistance.
The North Carolina Momnibus Act tracks closely with the federal Momnibus. If passed, SB 632 (and its identical companion HB 507) would establish one task force to develop recommendations for addressing social determinants of Black maternal health and respectful provision of care during public health emergencies, and a second task force to study access to care and maternal mortality outcomes among pregnant and postpartum veterans. It would also establish a grant program to fund community-based organizations promoting Black maternal health equity, and provide funding for data collection and research regarding maternal health outcomes during the COVID-19 pandemic. The state omnibus differs from the federal legislation in that it contains provisions establishing the specific rights of perinatal care patients and requiring the development of implicit bias training in partnership with Black-led community-based organizations and a historically Black college or university.
On April 27, 2021, Illinois enacted the Illinois Health Care and Human Services Reform Act (HB 158), a package championed by the Illinois Legislative Black Caucus to address structural racism through broad health care reforms. HB 158 addresses maternal health by providing Medicaid coverage for doula services and evidence-based home visiting services. It requires consulting practicing doulas and additional experts on doula care in the adoption of rules to administer maternal health care reforms. The bill also establishes a task force to conduct systematic reviews of state programs and departments and make recommendations for improved maternal health outcomes.
For more information about the state Momnibus bills, see our appendix here.
Additional State Efforts
In addition to state Momnibus bills, state advocates have been hard at work advancing additional bills to promote Black maternal health equity. Many bills address maternal health inequities by including Medicaid coverage for doula services (e.g., GA SB 727, DC Council Bill 240026) and extending Medicaid coverage to one year postpartum (e.g., CO SB21-194, IN HB 1155, NC SB 530, TX HB 133). Other bills establish advisory boards or review committees to investigate and report best practices for reducing racial inequities (e.g., AR HB 1580, KS HB 2018, NV AB119), create grant programs to fund maternal mortality prevention programs (e.g., FL H1383), and mandate implicit bias trainings for perinatal health professionals (e.g., NJ SB 703, OH HB 42).
*Helen Mun was a Spring 2021 intern in the National Health Law Program’s Washington, DC Office. She is a J.D. Candidate (2022) at Georgetown Law.