By Amani Echols, Lorena Bonet Velazquez, and Marla Guerra
What is a Momnibus?
Momnibus legislation aims to address the maternal mortality and morbidity crisis. Momnibus is a play on the word “omnibus,” which refers to a single bill that combines multiple policy proposals or the consolidation of multiple bills into a package. The composite bill or bill package may be officially titled a Momnibus and/or referred to as a Momnibus in advocacy materials and the media.
State Momnibus Scan inclusion criteria: Our team conducted online searches for state bills titled or described as a Momnibus. Consequently, there are maternal health bills introduced or enacted that were not considered in the scan, if not referred to as a Momnibus. To supplement the online findings, the research team conducted interviews with state advocacy teams to gather more information and context. Momnibus legislation fully or partially signed into law and/or Momnibus legislation introduced in 2025 are included in the scan. Momnibus legislation introduced before 2025 that did not pass was not included in this report.
Key Findings From State Momnibus Scan
- Thirteen states have partially or fully passed Momnibus legislation. Two of these states brought forward new Momnibus 2.0 legislation in the 2025 state legislative session that has not advanced.
- An additional four states introduced Momnibus legislation in the 2025 state legislative session, which have not advanced at this time.
- Of the 17 states that have passed and/or introduced a Momnibus, nine prioritized equity and centering communities most affected by the maternal health crisis through the policy development process.
- Expanding access to doula support, maternal mental health and substance use disorder care, and workplace accommodations and economic security were the most common topics in the Mominbus bill packages. Other common topics include expanding access to birth centers and midwifery care, lactation support, and digital and mobile health.
- Many programs, initiatives, and requirements authorized through Momnibus legislation were appropriated with no or minimal funds, resulting in slow, phased execution and implementation challenges. Cuts to the federal Medicaid program further restrict state budgets, which can make it harder for states to fulfill key priorities outlined in Momnibus legislation.
- Collaborative governance is a model and practice that engages birthing people and birth workers in the policymaking process to ensure equitable outcomes.
Table of Contents
I. Maternal Health in the United States
II. State Momnibus Overview
III. State Momnibus Content
IV. Case Studies from Policy Development to Implementation
a. Colorado: Community-Designed Policymaking
b. Michigan: Centering Black Birthing People
c. Kentucky: Garnering Bipartisan Support
d. California: Effective Implementation
V. Challenges in the Momnibus Policymaking Process
VI. Multiple Paths to Advancing State Maternal Health Policy
VII. Acknowledgments
I. Maternal Health in the United States
Among high-income countries, the United States is the most dangerous place to be pregnant and give birth. In the United States, two to three women die each day from pregnancy-related causes, and many more experience serious or life-threatening pregnancy-related complications. The risk of pregnancy is greater among Black and Indigenous birthing people. Compared to their white counterparts, Indigenous women are twice as likely and Black women are 3.5 times more likely to die from pregnancy-related causes. While the maternal mortality rate for Black women slightly increased from 2022 to 2023, the rate declined for Hispanic, Asian American, and white women, significantly worsening the disparity for Black birthing people. More than eighty percent of maternal deaths are preventable. Addressing the maternal health crisis requires a comprehensive set of solutions that includes targeting historical and ongoing racism and inequity. The federal Black Maternal Health Momnibus Act aims to equitably improve the maternal mortality and morbidity crisis.
The Federal Momnibus: A Coordinated Solution to Addressing the Maternal Health Crisis
The Black Maternal Health Momnibus Act, championed by the Black Maternal Health Caucus, was introduced in the previous 116th, 117th, and 118th congresses. It is an ambitious and critical package of legislation that addresses significant drivers of maternal mortality, morbidity, and disparities in the United States. The package was written by and for Black women, birthing people, and birth workers. Black Mamas Matter Alliance, past and present members of the Black Maternal Health Federal Policy Collective, and leaders of other birth justice organizations have played an instrumental role in spotlighting Black maternal health, founding the caucus, and laying a foundation for the Momnibus. The federal Momnibus bundles 13 bills addressing issues ranging from the social determinants of health, maternal mental health, perinatal workforce development, payment reform, and improving data collection and quality measures.
Since the Momnibus was first introduced in 2020, the Protecting Moms Who Served Act became law, the National Institutes of Health launched the Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative, and the caucus enacted over $200 million in Momnibus and other maternal health funding through the federal appropriations process. The Momnibus has not yet been reintroduced in the current 119th Congress. With gridlock at the federal level, advocates are increasingly interested in state efforts to pass comprehensive maternal health legislation.
II. State Momnibus Overview
Where, how, and with whom a person gives birth matters. People care deeply about the type of care and service providers who attend their birth. The support a person has access to while pregnant and in the postpartum period strongly influences people’s experiences and health outcomes. Legislation can shape how maternity care is provided and the resources available to childbearing families. Seventeen states have either passed (partially or fully) a Momnibus or introduced a Momnibus in the 2025 state legislative session.
III. State Momnibus Content
State legislation can advance even during times of federal gridlock because state bills can be tailored to state-specific needs and policy environments. Each state’s Momnibus package covers a wide range of topics to address the specific context of the state. That said, seven common priorities emerged across the 17 state Momnibus packages.
Comprehensive Description of State Momnibus Legislation that has been Enacted or Introduced in 2025 (as of October 15, 2025)
While this report does not aim to identify a model state Momnibus to avoid suggesting a one-size-fits-all approach, the scan highlights meaningful state efforts to address their specific needs. That said, standout and distinctive policies within each momnibus are marked by a star icon (
) at the top of the bulleted list.
Arkansas
|
Title |
Healthy Moms, Healthy Babies Act |
|
Bill Number |
|
|
Status |
Signed into law in 2025 |
|
Primary Sponsor |
Sens. Missy Irvin (R-24) and Breanne Davis (R-25) Reps. Aaron Pilkington (R-45), Jeff Wardlaw (R-94), Ashley Hudson (D-75), Lee Johnson (R-47), and Mary Bentley (R-54) |
|
Policies Included |
|
|
Champions |
The governor’s Strategic Committee for Maternal Health played an instrumental role in informing and advancing the bill. Other organizations involved include, but are not limited to Arkansas Blue Cross and Blue Shield, the Arkansas Chapter of the American Academy of Pediatrics, the Arkansas Community Health Worker Association, the Arkansas Perinatal Quality Collaborative, the Doula Alliance of Arkansas, Excel by Eight, Heartland Forward, the Heartland Whole Health Institute, the University of Arkansas for Medical Sciences, Walmart, and the Walton Family Foundation. |
California
|
Title |
The California Momnibus Act |
|
Bill Number |
|
|
Status |
Signed into law in 2021 |
|
Primary Sponsor |
Sen. Nancy Skinner (D-9) |
|
Policies Included |
|
|
Champions |
The Black Women for Wellness Action Project, the California Nurse-Midwives Association, March of Dimes, NARAL Pro-Choice California, the National Health Law Program, the Western Center on Law and Poverty, and the Women’s Foundation of California Women’s Policy Institute |
Colorado
|
Title |
Birth Equity Bill Package |
|
Bill Number |
|
|
Status |
Signed into law in 2021 |
|
Primary Sponsor |
SB-193 & SB-194: Sen. Janet Buckner (D-29) and Rep. Leslie Herod (D-8) SB-101: Sens. Rhonda Fields (D-28) and Tammy Story (D-25), Reps. Yadira Caraveo (D-31) and Dave Williams (R-15) |
|
Policies Included |
|
|
Champions |
Elephant Circle, with key support from Soul 2 Soul Sisters, the Colorado Organization for Latina Opportunity and Reproductive Rights, and over a dozen other community groups |
Connecticut
|
Title |
An Act Protecting Maternal Health |
|
Bill Number |
|
|
Status |
Signed into law in 2023 |
|
Primary Sponsor |
Gov. Lamont Sens. Saud Anwar (D-3) and Julie Kushner (D-24) Rep. Cristin McCarthy Vahey (D-133) |
|
Policies Included |
|
|
Champions |
The legislation was spearheaded by the governor’s office, with primary policy development led by the Department of Public Health, and supported by the Office of Early Childhood and the Office of Health Strategy. |
Delaware
|
Title |
Momnibus |
|
Bill Number |
|
|
Status |
Signed into law in 2022 |
|
Primary Sponsor |
Rep. Melissa Minor-Brown (D-17) |
|
Policies Included |
|
|
Champions |
Network Delaware, the Delaware Healthy Mother and Infant Consortium (a successor to the Infant Mortality Task Force), and the Do Care Doula Foundation |
|
Title |
The Georgia Maternal Health Momnibus Act |
|
Bill Number |
|
|
Status |
Introduced in April 2025 |
|
Primary Sponsor |
Reps. Park Cannon (D-58), Tanya Miller (D-62), Sandra Scott (D-76), Debra Bazemore (D-69), Carolyn Hugley (D-141), and Mekyah McQueen (D-61) |
|
Policies Included |
|
|
Champions |
SisterLove, Healthy Mothers Healthy Babies, Sister Song, Black Mamas Matter Alliance, Feminist Center for Liberation, the ACLU of Georgia, Faith and Public Life, and the Center for Black Women’s Wellness |
Illinois
|
Title |
Health Care and Human Service Reform Act |
|
Bill Number |
|
|
Status |
Signed into law in 2021 |
|
Primary Sponsor |
Rep. Camille Lily (D-78) Sen. Mattie Hunter (D-3) |
|
Policies Included |
|
|
Champions |
Ever Thrive, Start Early, Nurse Family Partnership, the Shriver Center on Poverty Law, and Health Connect One |
Indiana
|
Title |
Momnibus |
|
Bill Number |
|
|
Status |
Introduced in January 2025 |
|
Primary Sponsor |
SB-521: Sens. Andrea Hunley (D-46) & Vaneta Becker (R-50) SB-522: Sen. Andrea Hunley (D-46) |
|
Policies Included |
|
|
Champions |
Planned Parenthood, the Indiana Minority Health Coalition, Women for Change Indiana, and numerous doulas and birth centers participated in a roundtable that informed the development of the Momnibus |
Kentucky
|
Title |
Momnibus |
|
Bill Number |
|
|
Status |
Signed into law in 2024 |
|
Primary Sponsor |
Sens. Shelley Funke Frommeyer (R-24), Keturah Herron (D-35), Gerald A. Neal (D-33), Lindsey Tichenor (R-6), and David Yates (D-37) |
|
Policies Included |
|
|
Champions |
Planned Parenthood Alliance Advocates, the ACLU of Kentucky, the Kentucky Birth Coalition, Kentucky Voices for Health, Metro United Way, March of Dimes, the Kentucky Equal Justice Center, and the Right to Life |
Massachusetts
|
Title |
An Act Promoting Access to Midwifery Care & Out-of-Hospital Birth Options |
|
Bill Number |
|
|
Status |
Signed into law in 2024 |
|
Primary Sponsor |
Sens. Liz Miranda (D-2nd Suffolk) and Rebecca Rausch (D-Norfolk, Worcester, and Middlesex District) Reps. Marjorie Decker (D-25th Middlesex), Kay Khan (D-11th Middlesex), and Brandy Fluker-Reid (D-12th Suffolk) |
|
Policies Included |
|
|
Champions |
The Bay State Birth Coalition, the Center for Black Maternal Health and Reproductive Justice at Tufts University, Mind the Gap MA, the Neighborhood Birth Center, Mass Affiliate of the American College of Nurse Midwives, the National Association of Certified Professional Midwives, Reproductive Equity Now, Mass Planned Parenthood Defense Fund, Our Bodies Ourselves, Mystic Valley Action for Reproductive Justice, ACLU Massachusetts, MassNOW, the Planned Parenthood Advocacy Fund of Massachusetts, Birth Equity & Justice Massachusetts, MA Doula Coalition, and the Resilient Sisterhood Project |
Michigan
|
Title |
Momnibus |
|
Bill Number |
|
|
Status |
Passed Senate in April 2025 |
|
Primary Sponsor |
Sens. Erika Geiss (D- Taylor), Mary Cavanagh (D-Redford Twp.), Sarah Anthony (D-Lansing), Stephanie Chang (D- Detroit), and Sylvia Santana (D-Detroit) |
|
Policies Included |
|
|
Champions |
MI State of Birth Justice Coalition, Birth Detroit, Mothering Justice, the Michigan Chamber for Reproductive Justice, Elephant Circle, and several midwives and midwifery organizations in rural and urban areas across Michigan |
New Hampshire
|
Title |
Momnibus 1.0 |
|
Bill Number |
|
|
Status |
Enacted through the state budget in 2023 |
|
Primary Sponsor |
Sen. Rebecca Whitley (D-15) Rep. Carol McGuire (R-27) |
|
Policies Included |
|
|
Title |
Momnibus 2.0 |
|
Bill Number |
|
|
Status |
Passed Senate in March 2025 |
|
Primary Sponsor |
Sens. Denise Ricciardi (R-09) and Sue Prentiss (D-05) |
|
Policies Included |
|
|
Champions |
Reproductive Equity Now, New Futures, the New Hampshire Women’s Foundation, Moms Rising, Dartmouth Health, New Hampshire Medical, and the Catholic Diocese of Manchester |
New Jersey
|
Title |
Legislative Package to Combat New Jersey’s Maternal and Infant Health Crisis |
|
Bill Number |
|
|
Status |
Signed into law in 2019 |
|
Primary Sponsor |
Sens. Nellie Pou (D-35), Joseph P. Cryan (D-20), Teresa Ruiz (D-29), Linda Greenstein (D-14), Joseph F. Vitale (D-19) Reps. Shavonda E. Sumter (D-35), Eliana Pintor Marin (D-29), Pamela R. Lampitt (D-6), Eliana Pintor Marin (D-29)* *See the full list of primary sponsors, including retired members, on the bill webpages |
|
Policies Included |
|
|
Champions |
Montclair State University, the Central Jersey Family Health Consortium, NJ March of Dimes, NurtureNJ, and Ancient Song Doula |
North Carolina
|
Title |
Momnibus 3.0 |
|
Bill Number |
|
|
Status |
Introduced in March 2025 |
|
Primary Sponsor |
Sens. Natalie Murdock (D-20), Sydney Batch (D-17), Gladys Robinson (D-28) Reps. Julie von Haefen (D-36), Zack Hawkins (D-31), Vernetta Alston (D-29), Monika Johnson-Hostler (D-33) |
|
Policies Included |
|
|
Champions |
Aya Birth & Community Wellness, Equity Before Birth, MAAME (in Durham, NC), Jace’s Journey, March of Dimes, MomsRising, and Planned Parenthood |
Oregon
|
Title |
Momnibus |
|
Bill Number |
|
|
Status |
SB-690 and SB-692 were signed into law in June 2025. The other bills were introduced in 2025 but did not advance. |
|
Primary Sponsor |
Sens. Lisa Reynolds (D-17) and Deb Patterson (D-10) Reps. Dacia Grayber (D-28), Courtney Neron (D-26), Travis Nelson (D-44), Andrea Valderrama (D-47), and Kim Wallan (R-6) |
|
Policies Included |
|
|
Champions |
Oregon Perinatal Collaborative, the Oregon Doula Association, the Black Futures Initiative, the Children’s Institute, Our Children’s Oregon, Baby Blues Connection, Disability Rights Oregon, Nurture Coalition, ACOG Oregon Affiliate, ACCNM Oregon Affiliate, the Nurse-Family Partnership, Prevent Child Abuse, health systems and smaller direct-service perinatal organizations, Our Children Oregon, the Oregon Shield Coalition, Pineros y Campesinos Unidos del Noroeste, and APANO |
Pennsylvania
|
Title |
Momnibus |
|
Bill Number |
|
|
Status |
HB-1608 and HB-2127 were signed into law in 2024. HB-2137, HB-2138, and HB-2097 passed the House. The other bills did not advance. |
|
Primary Sponsor |
Pennsylvania Black Maternal Health Caucus Co-Chairs Reps. Morgan Cephas (D-Phila.), Gina H. Curry (D-Delaware), and La’Tasha D. Mayes (D-Allegheny) |
|
Policies Included |
|
|
Title |
Momnibus 2.0 |
|
Bill Number |
|
|
Status |
HB-1234 and HB-1088 passed the House in July 2025. HB-1212 passed the House in September 2025. The other bills were introduced in 2025 but have not advanced. |
|
Primary Sponsor |
Pennsylvania Black Maternal Health Caucus Co-Chairs Reps. Morgan Cephas (D-Phila.), Gina H. Curry (D-Delaware), and La’Tasha D. Mayes (D-Allegheny) |
|
Policies Included |
|
|
Champions |
The Black Women’s Policy Center, the Maternity Care Coalition, Healthy Start Pittsburgh, the Oshun Family Center, the Pennsylvania Doula Commission, and the Delaware County Foundation |
Virginia
|
Title |
Momnibus |
|
Bill Number |
HB-1614 |
|
Status |
Signed into law in May 2025 |
|
Primary Sponsor |
President Pro Tempore Sen. Louise Lucas (D-18) and Speaker Don Scott (D-88) Sen. Lashrecse D. Aird (D-13) Reps. Jeion A. Ward (D-87), Joshua G. Cole (D-65), Charniele L. Herring (D-4), Adele Y. McClure (D-2), Candi Mundon King (D-23), Destiny LeVere Bolling (D-80), Irene Shin (D-8), Rodney T. Willett (D-58), Amy J. Laufer (D-55), and C.E. Cliff Hayes, Jr. (D-91) |
|
Policies Included |
|
|
Champions |
Birth in Color |
Keep in mind that the high-level summary of each state’s Momnibus does not capture all the provisions included in each package or all of the actors involved in the policy development process and advocacy efforts. Please read the bill or law to obtain greater detail about each Momnibus. However, if you see information that needs to be updated or fundamental details missing, please email Amani Echols at aechols@nationalpartnership.org.
IV. Case Studies from Policy Development to Implementation
State advocates and legislators who have proposed strong maternal health bill packages generally shared several elements that contributed to their success: (1) collaborative governance, (2) legislation collaboratively drafted with language developed by members of the communities most impacted by the maternal health crisis and birth workers with experience working directly in those communities, (3) bipartisan collaboration, and (4) setting and establishing accountability for implementation goals. The following case studies from Colorado, Michigan, Kentucky, and California provide insight into how those states advanced maternal health legislation. These examples are provided to illustrate the policy development and implementation process, and the aim is not to highlight best practices.
Colorado: Community-Designed Policymaking
Signed into law in 2021, Colorado’s Momnibus (or Birth Equity Bill Package) strives to protect human rights and address discrimination, mistreatment, harm, poor outcomes, and inequities in outcomes during the perinatal period. The Momnibus also expanded access to midwifery care, extended Medicaid coverage postpartum to 12 months, and improved perinatal care data collection, among other initiatives.
In Colorado, the successful passage of the Momnibus was grounded in a collaborative governance model and practice using co-design principles. Various stakeholders, including community advocates, community-based organizations, and the government, worked together to address the complex maternal health issues in their state. Elephant Circle, a Colorado birth justice organization, championed the Colorado Momnibus in partnership with communities, families, community-based organizations, and birth workers, and helped guide the collaborative process. For over a decade, Elephant Circle had been cultivating an ecosystem of meaningful connections, trust-building, and active listening with birth workers and community members, making them more receptive to participating in developing the Momnibus when the opportunity presented itself. Three members of the bicameral Black Democratic Legislative Caucus of Colorado were motivated to take action to combat the persistent racial inequities in perinatal health and initiated a partnership with Elephant Circle to develop the Momnibus, recognizing the organization’s long-standing community engagement.
A positive feedback loop developed between community partners and policymakers through in-depth conversations, circles, and gatherings held across the state over several years. A survey of 77 Coloradan birth equity leaders, a majority of whom were Black, Indigenous, and people of color, confirmed the anecdotal stories and priorities expressed earlier in the process by community members and provided additional data to inform the policy proposals. The Colorado Birth Equity Bill Package was guided by the direct, lived experiences of people who receive, provide, and support perinatal care in Colorado.
The level of community engagement achieved throughout the process helped promote intersectional policymaking. The result of this decade of building trust and meaningful community engagement ensured that families of color, Indigenous families, undocumented families, families who are experiencing poverty, LGBTQIA+ families, parents who use drugs, and parents who have been impacted by incarceration and/or over-policing and surveillance all benefit from the bill package. The Colorado Birth Equity Bill Package was successfully rooted in the belief that human rights are a health outcome, which required active community participation in policymaking and prioritized ongoing government accountability to community members. Since the passage of the Colorado Momnibus, a diverse coalition has met weekly to oversee the implementation of the provisions in the package – a process referred to by Elephant Circle as “community-based implementation power.” Elephant Circle continues to engage in policy co-design with the community through state-based listening circles and the collection of policy ideas and interventions through a form on their website.
Michigan: Centering Black Birthing People
Following the successful passage of the Colorado Momnibus, Michigan birth workers and advocates collaborated with Elephant Circle to develop a bill package tailored to the needs of Michiganders. The Michigan Momnibus drew inspiration from the Colorado Momnibus as a starting point, and it is similarly rooted in an equity approach. The Michigan bill package seeks to dismantle systemic barriers that disproportionately harm Black and Brown birthing people and to expand access to midwifery care, doula support, and coverage of perinatal services, including remote patient monitoring, under Medicaid.
The community-based organizations championing the Momnibus – the Michigan State of Birth Justice Coalition, Birth Detroit, Mothering Justice, and the Michigan Chamber for Reproductive Justice – are predominantly led by Black women. Furthermore, one of the congressional champions, Senator Erika Geiss (D-6), is a Black woman whose district includes Birth Detroit, the first and only community freestanding birth center in the city of Detroit. The advocates also built connections with birth workers in rural areas to ensure the birth community was united in accounting for, and meeting the needs of, both rural and urban community members.
The Michigan Momnibus, first introduced in 2024, was reintroduced in 2025 with slight modifications. The 2024 and 2025 versions of the Momnibus were both drafted with an equity lens, meaning lawmakers and advocates specifically included provisions focused on the most impacted communities (e.g., Black birthing people and rural areas). Despite the legislature having become more conservative between 2024 and 2025, advocates maintained the equity lens as a non-negotiable focus. To date, the Michigan Momnibus has passed the Senate and is awaiting movement in the House. Michigan’s strategy, as it has pivoted in its messaging, is noteworthy because it embodies the principles of targeted universalism, emphasizing the need for targeted approaches for Black birthing people and rural areas to improve maternal and infant health for all Michiganders. Since its inception in 2022, the Michigan State of Birth Justice Coalition has worked to build urban-rural partnerships to increase access to midwifery care across the state. Additionally, Michigan advocates have invested in storytelling and launched the “Birth Is Bipartisan” campaign, providing branded merchandise to community members, advocates, and lawmakers, framing the maternal health narrative as one that unites all people.
Kentucky: Garnering Bipartisan Support
The Kentucky Momnibus was signed into law in 2024, following the state’s abortion ban, which led to the health outcomes of pregnant people worsening and an exodus of obstetric care providers. Legislators in the Republican majority sought to boost public approval ratings by taking steps they could promote as being “pro-mother.” They sought to demonstrate this by supporting the state’s Momnibus package. Republican legislators introduced the package in 2024, although Planned Parenthood Alliance Advocates of Kentucky and the American Civil Liberties Union (ACLU), alongside the Democratic Women’s Caucus, had laid the groundwork long before by drafting and introducing the bills in previous legislative sessions.
Bipartisan cooperation played an essential role in moving this bill forward. Republican sponsors attempted to add anti-abortion language to the package that would have required hospitals and midwives to refer patients with nonviable pregnancies or whose fetuses had been diagnosed with fatal conditions to “perinatal palliative care services,” deterring them from seeking an abortion. Lawmakers ultimately removed the language from the bill due to objections by Democratic leadership and leading advocacy organizations. Both sides reached an agreement and advanced a bill that prioritized the needs of pregnant people by increasing access to perinatal health care coverage, lactation support, care for perinatal mental health and substance use disorder, among other initiatives.
California: Effective Implementation
California’s Momnibus passed in 2021 and codified the state’s Pregnancy-Associated Mortality Review Committee, reduced enrollment barriers for pregnant people to enroll in the California Work Opportunity and Responsibility to Kids program, and funded (upon appropriation) midwifery programs that include training on medically underserved communities, among other transformative reforms. Medi-Cal coverage of doula support had been included in an early iteration of the California Momnibus but was removed when doula Medicaid coverage was included in the state budget. Building on this success, the California Momnibus shifted course to establish a Doula Implementation Workgroup comprised of doulas, health care providers, and community advocates. The workgroup was tasked with ensuring the new Medi-Cal doula benefit would be implemented effectively and in a way that would best meet the needs of community members and service providers. The workgroup was responsible for providing a report to the Department of Health Care Services (DCHS) to inform and recommend improvements for outreach efforts regarding doula services, offer strategies to reduce systemic barriers for birthing people, and provide data on the utilization of doula services through the Medi-Cal program.
Writing the implementation workgroup into the California Momnibus is a key example of how lawmakers can bake implementation strategies directly into legislation to ensure it achieves its intended impact and to increase the likelihood of genuine community engagement. The doulas in the workgroup were compensated for their time and expertise – a critical component of the workgroup’s success. Obtaining funding, whether through the state budget or a philanthropic grant, to support the participation of all community advisers is essential to ensure the relevant stakeholders can afford to carve out time to participate. Additionally, funding for a third party to facilitate the workgroup meetings was instrumental in building trust, balancing power, and fostering constructive conversations between the community advisors and DCHS. All reports, products, and meeting materials are posted on DCHS’ website for transparency and as an accountability mechanism to ensure that the health department truly integrates the workgroup’s input. Involving doulas in the implementation of the Medi-Cal doula benefit has been invaluable in ensuring the workgroup’s recommendations are relevant and meet the needs of doulas and families.
V. Challenges in the Momnibus Policymaking Process
States experienced common challenges in developing and implementing their Momnibus:
Funding Momnibus Legislation
Implementation is often where bills with the best of intentions fail to realize their promise for change. There were Momnibus packages that became law, but lawmakers failed to appropriate the funds needed to implement the legal requirements. It is common for states to pass bills without immediately providing funding, with the expectation that funding will be allocated during a future budget cycle. Budget constraints hinder the timely and adequate allocation of funds, resulting in the phased implementation of Mommibus legislation over several years. Consequently, the law has not fully met its expectations or promises.
State advice: As a way to hold the government accountable, constituents have submitted Freedom of Information Act requests to gain access to information and updates on the status of implementation. Additionally, some states have found it easier to fund the expansion of an existing evidence-based program rather than funding a new pilot program. States have also found success by strategically passing specific provisions of Momnibus bills through the budget process, as California did with its doula Medicaid benefit, or passing the entire Momnibus through the budget process, which is how New Hampshire enacted its first Momnibus package.
Medicaid Is a Crucial Component of State Momnibus Packages
States face extreme financial pressure on their state budgets when federal budget cuts are proposed or enacted. The cuts to the federal Medicaid program in the enacted 2025 Republican budget bill will make it harder for states to fulfill key priorities outlined in Momnibus legislation, such as Medicaid coverage for perinatal services, including doula and midwifery care, Medicaid pilot programs, Medicaid payment reform initiatives, and expanding access to Medicaid generally. There are overlapping priorities among states with a Momnibus and a part of the Centers for Medicare & Medicaid Services’ Transforming Maternal Health (TMaH) Model, which is a maternity care delivery and payment reform model initiative. These states include Arkansas, California, Illinois, and New Jersey.
Centering Equity
The Federal Black Maternal Health Momnibus centers the experiences of Black birthing people and strives for equitable advancements in maternal and infant health. States took three different approaches with respect to focusing on equity and centering the experiences of birthing people most impacted by the maternal health crisis in their Momnibus packages:
- Internally and Externally Grounded: States successfully passed Momnibus legislation that centers equity explicitly in its language and messaging, especially in states with Democratic majorities in both state houses and states with supportive governors. For other states, these Momnibus packages are aspirational bills that, while unlikely to advance in the short term, can spark and guide a long-term conversation that may lead to incremental improvements and greater education on the issue. States in this category were most likely to utilize a collaborative governance approach.
- Internally Grounded but Externally Ungrounded: In several states, advocates and legislators have applied an equity lens as part of their internal strategy and policymaking process, so their Momnibus is designed to have an equitable impact, but does not name equity as an explicit goal in the legislation. This approach may allow them to garner greater bipartisan support from Republican legislators.
- Internally and Externally Ungrounded: For these states, there is an understanding that the maternal health crisis disparately impacts specific communities, but equity is not centered in the policymaking process due to the local political context, make-up of the stakeholders involved in the policymaking process, or demographics of the state. In the face of the federal ban on diversity, equity, and inclusion efforts, more states will face challenges in explicitly applying equity frameworks to their policymaking processes.
State advice: It is essential to advance a Momnibus that is at least internally grounded in equity to reduce racial disparities in maternal health. To achieve this, it is crucial to engage the right coalition of partners from the outset. Community-based organizations, birth workers, and community members should not only be at the decisionmaking table but also be the ones building the table from the start, as they best understand the problem and solutions.
Garnering Bipartisan Support
In states with strict abortion bans and pronatalist sentiments, some conservative lawmakers are interested in improving their narrative so they can appear supportive of families and invested in improving maternal and infant health, as exemplified through Kentucky’s case study. Passing legislation that supports healthy moms and babies can help the anti-abortion movement and conservative legislators appeal to the public amid restrictive abortion laws that are associated with worsening maternal and infant outcomes. Leveraging the anti-abortion advocacy movement, however, can be a risky endeavor. Several states have had to engage in targeted advocacy to remove harmful anti-abortion riders added to Momnibus bills. Furthermore, drafting legislation that appeals to and/or aims to leverage the anti-abortion movement can fuel distrust from birthworkers and birthing people, which may prevent them from engaging in the policymaking process.
State advice: If gaining bipartisan support is needed for a Momnibus to advance but remains impossible or would extract too high a cost, a well-supported single bill or provision from the Momnibus can be pulled out to champion individually. This may allow incremental change while maintaining the Momnibus’s original objectives. Secondly, focus on relationship building so your organization becomes the go-to resource on maternal health among lawmakers across the aisle. Also, consider collaborating with advocacy groups in other states to gain insights into their policymaking process and legislative strategy. For example, Kentucky’s Momnibus was an invaluable roadmap for Indiana.
VI. Multiple Paths to Advancing State Maternal Health Policy
Passing comprehensive maternal health legislation into law is no easy feat. States such as Minnesota and Wisconsin have been unsuccessful in passing Momnibus legislation. But in the long run, these efforts help inform state legislators about the maternal health crisis, lay the groundwork for a future maternal health legislative win, and motivate other stakeholders, including hospitals, insurers, and nonprofit organizations, to voluntarily adopt components of Momnibus legislation (e.g., doula coverage or innovative care coordination models). Additionally, local jurisdictions have the opportunity to bolster and fill in the gaps of state-level maternal health policies; for example, New York City passed a Momnibus legislative package in 2022.
Furthermore, a Momnibus is not the sole strategy for advancing comprehensive maternal health legislation, especially as some lawmakers prefer to pass bills individually rather than bundled into omnibus packages. For instance, improving access to doulas and midwives has been a high priority for many state advocates, within and separate from Momnibus legislation. Multiple resources offer guidance on best practices for specific policies often included in state Momnibus packages:
- National Health Law Program: Best Practices for Medicaid Coverage of Doula Care (2025)
- Institute for Medicaid Innovation: A Blueprint for Improving Maternal and Infant Health Outcomes Under Medicaid (2023)
- American Association of Birth Centers: Best Practices in Birth Center Regulations (2021)
- National Association of Certified Professional Midwives: 2025 Legislative and Policy Efforts
- Policy Center for Maternal Mental Health: Model Maternal Mental Health State Legislation
- U.S. Breastfeeding Committee: Breastfeeding Policy Map
- Kaiser Family Foundation: Telemedicine and Pregnancy Care
We hope this resource galvanizes collaborative governance within states, promotes cross-state collaborations, and sparks the introduction of comprehensive maternal health legislation nationwide. Momnibus legislation, if done comprehensively, with attention to equity, and involving the right stakeholders, has the potential to transform state maternity care systems.
VII. Acknowledgments
We are deeply grateful to the state advocates for advancing critical maternal health legislation and for sharing their expertise and insights to support other state efforts.
Issue brief was authored by:
- Amani Echols, Senior Manager of Maternal and Infant Health, NPWF
- Lorena Bonet Velazquez, Health Justice Policy Associate, NPWF
- Marla Guerra, Health Justice Intern, NPWF
The following people contributed to this report:
- Nan Strauss, Senior Policy Analyst for Maternal Health, NPWF
- Jamille Fields Allsbrooks, Assistant Professor of Law, Howard University; Senior Fellow, NPWF
- Stephanie Green, Coalition and Partnerships Manager for Health Justice, NPWF
- Erin Mackay, Managing Director for Health Justice, NPWF
- Jorge Morales, Editor
About the National Partnership: The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to achieving equity for all women. We work to create conditions that improve the lives of women and their families by focusing on achieving workplace and economic equity, and advancing health justice by ensuring access to high-quality, affordable, and equitable care, particularly for reproductive and maternal health. We are committed to combating white supremacy and promoting racial equity. We understand that this requires us to abandon race-neutral approaches and center the intersectional experiences of women of color to achieve our mission. Support for this resource was provided by the Skyline Foundation.
The Skyline Foundation provided generous support for this work.
