H.R. 6303 — CARE for Moms Act

This section states congressional findings on the maternal mortality crisis in the United States, including that nearly 4,000,000 women give birth annually, over 1,000 suffer fatal complications from pregnancy or postpartum periods, and approximately 70,000 experience near-fatal complications; the maternal mortality rate (deaths per 100,000 live births) rose from 14.5 in 2000 to 32.9 in 2021 (the only industrialized nation with an increasing rate); over 80% of deaths are preventable; rates vary by race and ethnicity (e.g., 26.6 for White women, 69.9 for non-Hispanic Black women, 32.0 for American Indian/Alaska Native women) and age (138.5 for women 40 and older vs. 20.4 for those under 25); and COVID-19 contributed to 25% of maternal deaths in 2020 and 2021. The section further finds that leading causes include hemorrhage, cardiovascular conditions, infection, and mental health issues (most preventable or manageable); doula care reduces low-birthweight babies by fourfold and birth complications twofold; intimate partner violence is a leading cause exacerbated by COVID-19; and oral health affects perinatal outcomes.

This section establishes a State-Based Perinatal Quality Collaborative grant program under which the Secretary of Health and Human Services, acting through the Centers for Disease Control and Prevention, awards grants of up to $250,000 per year to eligible entities to develop and sustain multidisciplinary networks advancing evidence-based perinatal care in every state, the District of Columbia, and eligible territories, with $35 million authorized annually for FY2026 through FY2030. The section requires state Medicaid programs to cover oral health services—defined as preventive, diagnostic, periodontal, and restorative dental care consistent with specified professional guidelines—for women during pregnancy and the 1-year postpartum period (adding new mandatory service under SSA section 1905(a)(4)(G) and (jj)). It further requires state Children's Health Insurance Program (CHIP) benchmark dental packages to cover such services for pregnant women and pregnant children. The section mandates 12 months of continuous full-scope Medicaid coverage for pregnant and postpartum individuals (converting prior state option under SSA section 1902(e)(16) to a requirement and cross-referencing in section 1902(a)(88)); it applies the same requirement to CHIP through conformity amendment to section 2107(e)(1)(J). (Thus, states must maintain eligibility for pregnant women through 12 months postpartum regardless of income or other changes, with federal matching funds.)

This section establishes a program under which the Secretary of Health and Human Services awards grants or contracts to eligible entities—including health professions schools, schools of public health, academic health centers, governments, tribes, and community-based organizations—to establish or expand training programs for full spectrum doulas (i.e., professionals providing continuous physical, emotional, and informational support across the full spectrum of reproductive experiences, including pregnancy, birth, postpartum, and abortion). Grant funds support (1) new doula education and certification programs; (2) expansion of existing programs, including through scholarships for students committing to serve underserved communities; and (3) recruitment and retention of students from underserved communities, including racial and ethnic minorities facing high maternal mortality rates. The section appropriates $50 million for FY2026, to remain available until expended.

This section establishes a pilot grant program, to be administered by the Health Resources and Services Administration, under which the Secretary awards grants to states (1) to purchase and equip rural mobile health units to provide pre-conception, pregnancy, postpartum, and obstetric emergency services in rural and underserved communities; (2) to train providers—including obstetrician-gynecologists, certified nurse-midwives, nurse practitioners, nurses, and midwives—to operate such units and handle obstetric emergencies; and (3) to address access barriers, including social determinants of health and wraparound services such as nutrition, housing, lactation support, and transportation. As a condition of receiving grants, states must assure that no personally identifiable information on pregnant or postpartum individuals is shared with law enforcement; grants last up to five years; and grantees must submit implementation reports to the Secretary at three and six years after enactment, including quantitative maternal health indicators (stratified by race, ethnicity, sex, gender identity, primary language, age, geography, disability status, and insurance status) and qualitative patient experience measures. The Secretary must evaluate the program's impact on maternal health outcomes, state maternity care spending, and patient experience (with stratified data); submit a report to Congress within one year after the pilot ends, including a recommendation on continuation and national expansion beyond FY2030; and $10 million is authorized for each of FY2026 through FY2030.

This section requires Medicare-participating hospitals, beginning 180 days after enactment, to notify the Secretary at least 90 days prior to closing an obstetric unit. The notification must include (1) a report analyzing the closure's impact on the community, (2) steps the hospital will take to identify other providers to alleviate resulting service gaps, and (3) any additional information required by the Secretary.

This section directs the Secretary of Health and Human Services to submit to Congress, not later than 24 months after enactment, a report identifying where maternal health needs are greatest in the United States and analyzing federal expenditures to address those needs during 2000 through 2024. The report must include (1) analysis of how federal maternal health funds provided to states were distributed across regions, states, localities, and counties; (2) barriers to applying for and receiving such funds, including requirements for partnerships with other entities and stringent network requirements; and (3) reasons applicants did not receive funding, such as limited availability of funds, application strength, or failure to meet requirements. The report must disaggregate data on mothers served by race, ethnicity, insurance status, and language spoken.

This section increases federal excise taxes on tobacco products to establish tax rate parity across categories (i.e., aligning rates for non-cigarette products with cigarette-equivalent levels), doubles cigarette taxes, adds taxes for certain FDA-regulated products, provides for inflation adjustments after 2025, and imposes floor stocks taxes on inventory held before tax increase dates. Specifically, it (1) increases the tax on roll-your-own tobacco to $49.56 per pound (from $24.78); (2) increases the tax on pipe tobacco to $49.56 per pound (from $2.8311); (3) increases smokeless tobacco taxes to $26.84 per pound on snuff (from $1.51), $10.74 per pound on chewing tobacco (from $0.5033), and $100.66 per thousand on discrete single-use units (newly defined to include lozenges, pouches, etc.); (4) increases the tax on small cigars to $100.66 per thousand (from $50.33); (5) changes the large cigar tax to $49.56 per pound, not less than $0.10066 per cigar (from 52.75% of manufacturer price, not less than 5.015 cents); (6) doubles small cigarette taxes to $100.66 per thousand (from $50.33) and large cigarette taxes to $211.38 per thousand (from $105.69); and (7) taxes other FDA-determined tobacco products at cigarette-equivalent rates on a per-use basis (new). (Thus, these changes approximately double most rates to match cigarette taxes per pound or unit, increasing Treasury revenue from chapter 52 excise taxes imposed on manufacture/importation.)