Policy Tracker
Federal and state policy developments that affect the reimbursement environment, funding landscape, and operating context for maternal and pediatric health companies.
AAP Policy Statement on Racial Disparities in Breastfeeding Calls for Fair Payment for Lactation Services
The AAP identifies structural barriers driving breastfeeding disparities and recommends — most consequentially — securing fair payment for lactation services and supplies. A third data point in the professional-society-endorses-component-service pattern following ACOG doula guidance and the Arkansas doula/lactation SPA.
MassHealth updates CBHI payment methods and adds FIT service
CMS approved Massachusetts SPA MA-25-0023, updating payment methods for the Children's Behavioral Health Initiative and formally adding the Family-based Intensive Treatment service for members age 20 and younger.
Arkansas Medicaid adds doula and lactation consultant coverage
CMS approved Arkansas SPA AR-26-0004, adding Medicaid coverage for doula services and breastfeeding and lactation consultant services. Reimbursement went live September 1, 2026 in a state where roughly 60% of births are Medicaid-funded.
ACOG Committee Statement: Partnering With Doulas in Clinical Settings
ACOG released a committee statement setting five recommendations for ob-gyns to integrate doulas into clinical care teams, grounding them in outcomes evidence and acknowledging variable state Medicaid coverage.
Michigan Medicaid Moves to Unbundled Maternity Billing for January 2027
Michigan DHHS issued a provider alert confirming global maternity codes will be deleted January 1, 2027 and that Michigan Medicaid will transition to separate CPT codes — the first state Medicaid agency PHD has tracked to publish an implementation timeline.
CMS Proposes 15 Maternity G-Codes in CY2027 PFS, Preserving the Global Fee Alongside Unbundling
CMS recognized the new AMA/ACOG obstetric CPT codes and then proposed 15 HCPCS G-codes that would let any payer keep the old bundled global maternity payment structure. Comments closed September 14, 2026 without proposed antepartum or postpartum component rates ever being published.
OB-GYN Payment Unbundling Set for January 1, 2027
New AMA-adopted OB-GYN billing codes will let clinicians bill insurers for individual maternity services starting January 1, 2027, replacing the traditional bundled global maternity payment and potentially reshaping how maternal health tech vendors get paid.
FDA Accepts Arcutis sNDA for ZORYVE (roflumilast) Cream 0.05% in Infants Down to 3 Months With Atopic Dermatitis
Arcutis announced the FDA accepted its supplemental NDA to expand ZORYVE cream 0.05% for atopic dermatitis to infants aged 3 to 24 months, with a PDUFA date of February 23, 2027.
Pallone-Wyden Report Documents Maternity Ward Closures One Year After OBBBA
House and Senate ranking members released a report documenting maternity unit closures and service cutbacks one year after OBBBA's enactment, including state-by-state mapping of Medicaid state-directed payment programs at risk under the law's new payment caps.
FDA Expands Casgevy to Children Ages 2 and Older With Sickle Cell Disease and Transfusion-Dependent Beta Thalassemia
The FDA approved a supplemental indication for Vertex's Casgevy (exagamglogene autotemcel), extending use to patients ages 2 and older — the first gene therapy approved for children as young as 2 with sickle cell disease.
FDA Approves Arcutis' ZORYVE (roflumilast) Cream 0.3% for Plaque Psoriasis in Children as Young as Age 2
The FDA approved Arcutis' supplemental NDA expanding ZORYVE cream 0.3% for plaque psoriasis to pediatric patients down to age 2, the first once-daily steroid-free topical approved for plaque psoriasis in this age group.
CMS Interim Final Rule on Medicaid Work Requirements (CMS-2454-IFC)
CMS issued an interim final rule implementing H.R. 1's Medicaid work requirements. Pregnant and postpartum enrollees and parents of children 13 and under are exempt, but exemptions are administered rather than automatic. State outreach window (June 30–August 31) is the leading indicator of January disenrollment volume.
FDA Accepts BMS sNDA for Priority Review: Camzyos (mavacamten) in Adolescents with Obstructive HCM
The FDA accepted for Priority Review a Bristol Myers Squibb sNDA to extend Camzyos (mavacamten) to adolescents aged 12–17 with symptomatic obstructive hypertrophic cardiomyopathy. Paired with Renata Medical's August Series D, an approval would give the pediatric label wave a cardiology chapter.
UnitedHealthcare Eliminates Nearly Two-Thirds of Pediatric Prior Authorization Requirements
UnitedHealthcare announced it will remove about two-thirds of prior authorization requirements for members under 18 by end of 2026, covering commercial and Medicaid plans across diagnostic imaging, outpatient testing, and surgical procedures.
Maternal Health Pandemic Response Act Reintroduced (Momnibus)
Rep. Lucy McBath, Sen. Elizabeth Warren, and Rep. Lauren Underwood led more than 70 lawmakers in reintroducing the Maternal Health Pandemic Response Act, a Momnibus component funding maternal-infant health programs and tightening maternal-health data collection standards.
Geisinger Health Plan Commits to Maternity CPT Unbundling Across All Plan Offerings
Geisinger Health Plan published a provider notice committing to full maternity CPT unbundling across commercial, Medicaid (GHP Family), and CHIP (GHP Kids) plan offerings — two months before CMS proposed the G-code escape hatch. The counter-evidence to the "commercial payers are silent" reading.
ACOG Tells Health Plans to Move Antepartum Billing to E/M Codes by September 1, 2026
Alongside the AMA release of the new obstetric CPT codes, ACOG recommends health plans accept standard E/M codes for antepartum visits without visit limits or preauthorization by September 1, 2026 — the operational deadline that the January 1, 2027 date obscures. Plans not ready by September 1 will generate denials on every pregnancy that starts after that date.
FDA Clears Dexcom Stelo as First OTC Continuous Glucose Monitor for Children
The FDA cleared Dexcom's Stelo Glucose Biosensor System for over-the-counter use in children as young as two who do not use insulin, the first OTC continuous glucose monitor indicated for a pediatric population, cleared on real-world evidence without a dedicated pediatric trial.
FDA Grants Accelerated Approval to Tzield for Newly Diagnosed Pediatric Stage 3 Type 1 Diabetes
The FDA granted accelerated approval to Tzield (teplizumab) for pediatric patients ages 8 through 17 recently diagnosed with Stage 3 type 1 diabetes, the first treatment approved to delay the decline of insulin production after diagnosis rather than delay disease onset.
2026 Maternal Mental Health State Report Cards (Policy Center for Maternal Mental Health + GW Milken)
Fourth annual scorecard from the Policy Center for Maternal Mental Health and GW Milken. The U.S. earned a C overall (up from C-); ten states earned Bs for the first time. A new Parental Support domain — covering paid leave and childcare — debuted with a U.S. score equivalent to an F. The most cited state-level scorecard in the category just widened its frame from clinical services toward family economic supports.
CMS Proposes Caps on Medicaid Directed Payments and Targeted FFS Payments
CMS proposed capping many Medicaid managed-care state directed payments at 100–110% of Medicare rates and applying similar limits to targeted FFS practitioner payments — projecting $775 billion in ten-year savings. Directly affects children's hospitals, safety-net providers, pediatric value-based entities, and Medicaid-facing startups whose unit economics depend on state payment enhancements.
CMS Opens Public Comment on Medicaid HCBS Measures for Children, Youth, and Young Adults
CMS opened a public comment period on new quality measures for children, youth, and young adults receiving Medicaid-funded HCBS. Developed with Mathematica and HSRI. Comment period closes June 8, 2026. An early signal that pediatric Medicaid quality measurement is expanding into longitudinal community-based care performance.
Moms Matter Act Reintroduced as Part of Momnibus Package
Sens. Gillibrand and Blunt Rochester, with Reps. Clarke and Fitzpatrick, reintroduced the bipartisan Moms Matter Act as part of the Momnibus package. Grant programs target community-based maternal mental-health programs and workforce expansion. Bipartisan sponsorship and workforce framing matter more than near-term passage odds.
CMS Updates EPSDT Coverage Guide for Children in Medicaid and CHIP
CMS released an updated EPSDT coverage guide for states reaffirming that prior authorization cannot delay medically necessary services and that hard service caps are impermissible — a utilization tailwind and negotiating lever for pediatric behavioral-health and digital-care vendors contracting with state Medicaid programs.
HHS Announces Heartland Forward MOU to Advance Maternal Health
HHS's Office on Women's Health signed a memorandum of understanding with Heartland Forward to advance maternal health outcomes, supporting expansion of the HHS Perinatal Improvement Collaborative across more than 220 hospitals. A federal signal that maternal quality infrastructure remains a live policy and procurement theme.
HHS Launches Moms.gov
HHS launched Moms.gov as a new federal information hub for expecting and new mothers, aggregating resources on pregnancy centers, FQHCs, breastfeeding, nutrition, and mental health. Watch whether it evolves into a navigation gateway or formal referral channel.
Proposed Federal Budget Targets Title X, Healthy Start, and CDC Safe Motherhood Programs
HHS Secretary RFK Jr. defended a proposed budget eliminating Title X family planning funding, Healthy Start, and the CDC Safe Motherhood and Infant Health Portfolio. A policy-risk signal that could narrow referral infrastructure and reduce community-program support for Medicaid-heavy maternal health models.
HRSA Finalizes Revised Criteria for Maternity Care Health Professional Target Areas
HRSA finalized revised MCTA criteria removing the Social Vulnerability Index from scoring and reallocating its two points to population-to-provider ratios and travel time. The change affects which geographies qualify for NHSC loan repayment and where federally supported maternity providers are placed.
HHS Launches Psychiatric Overprescribing Action Plan
HHS announced a MAHA action plan targeting psychiatric overprescribing with explicit focus on children and adolescents, including CMS deprescribing guidance, a Dear Colleague letter, and planned SAMHSA/FDA activities. Signals a federal posture shift that creates headwinds for medication-forward behavioral health models and tailwinds for therapy and care-navigation platforms.
CMS ASPIRE Model — Pediatric Complex Care Medicaid Initiative
CMS launched ASPIRE, a 10-year voluntary state-based program allocating $125M for up to five states to deliver whole-person care for Medicaid and CHIP enrollees up to age 21 with complex conditions. Applications closed May 17. State ASPIRE contracts will be among the most valuable pediatric value-based care opportunities of 2027.
Nebraska Becomes First State to Implement OBBBA Medicaid Work Requirements
Nebraska became the first state to implement Medicaid work requirements on May 1, 2026, eight months ahead of the OBBBA federal deadline. Pregnant women, mothers up to 12 months postpartum, and children are explicitly exempt.
North Carolina Proposes Sweeping ABA Medicaid Oversight Revisions
NC DHHS proposed revisions to Clinical Coverage Policy 8F that would tighten ABA provider oversight and restrict telehealth for ABA service delivery — the first major state-level ABA tightening signal of 2026.
FDA Approves Otarmeni for Genetic Hearing Loss
FDA approved Otarmeni (lunsotogene parvec-cwha) for severe-to-profound sensorineural hearing loss tied to biallelic OTOF variants — the first dual AAV vector-based gene therapy and first approved gene therapy for inherited hearing loss.
Virginia DMAS RFI — Maternal Health Desert Mobile Clinic Pilot Program
Virginia DMAS opened RFI-118360 for a Maternal Health Desert Mobile Clinic Pilot Program on April 17, 2026 — a state purchasing signal for mobile clinic operators, prenatal and postpartum telehealth platforms, and maternal care-coordination vendors.
Florida KidCare CHIP Expansion Stalled — 42,000 Children Still Waiting
Two years after Florida lawmakers unanimously passed an expansion of KidCare (200% to 300% FPL), approximately 42,000 children remain uninsured and waiting. A lawsuit filed in March 2026 seeks to compel AHCA to implement the law.
FDA Clears Earflo At-Home Pediatric Ear Pressure Treatment
Earflo received FDA clearance for its at-home device for children as young as two with negative middle-ear pressure and fluid buildup, positioned as an option during the watchful-waiting period before ear tube surgery.
Maine Budget Creates Reproductive Health Funding Shield Against Federal Cuts
Maine's 2026 budget proposes $5M/year beginning in 2027 to replace federal reproductive health funding if cut, and would have the state absorb Medicaid reimbursement costs if federal support is reduced — a Tier One Defender posture in the emerging state policy landscape.
Wisconsin Extends Postpartum Medicaid Coverage to 12 Months
Wisconsin enacted SB 23 extending postpartum Medicaid from 60 days to 12 months for eligible birthing parents, effective July 1, 2026 pending federal approval.
Title V MCH Block Grant — Georgetown CCF Advocacy Report on State Dependence and Funding Gaps
Georgetown CCF documented state reliance on Title V MCH funding and argued that $818.70M in FY2026 appropriations is structurally insufficient to address maternal and infant mortality.