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H 1268

An Act supporting maternal and pediatric health

194th Legislature (2025-2026) Introduced by Jamie Eldridge and 2 co-sponsors

The bill requires coverage for a prenatal pediatric visit by public and private plans in Massachusetts to support early family-pediatric partnership.

Hearing scheduled for 10/08/2025 from 10:30 AM-02:30 PM in Gardner Auditorium
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Bill Summary · H 1268

Summary: An Act supporting maternal and pediatric health (H 1268)

Purpose and intent

  • The bill seeks to ensure that prenatal care includes access to a prenatal pediatric visit—defined as a meeting between a pregnant person and a pediatrician to establish a foundation for a family-pediatric partnership, per the American Academy of Pediatrics.
  • It requires a broad set of Massachusetts health plans and state-sponsored coverage to include this prenatal pediatric visit as part of medical expense coverage.

Key provisions and changes

The bill adds the prenatal pediatric visit to multiple streams of health coverage across several General Laws chapters. The core concept is consistent across sections: every relevant plan or contract must cover a prenatal pediatric visit.

1) Chapter 32A (new Section 33)
- Coverage by the Commonwealth’s group insurance commission for active or retired employees must include a prenatal pediatric visit.
- Definition: same as above (pediatrician-pregnant person visit to support a positive family-pediatric partnership per AAP).

2) Chapter 118E (new Section 10R)
- Medicaid managed care plans and related contractors must cover a prenatal pediatric visit.
- The division must notify members in writing about the coverage, prominently in member communications, within the calendar year when annual information is distributed.

3) Chapter 175 (new Section 47UU)
- Any medical expense insurance policy/contract issued or renewed in Massachusetts must provide coverage for a prenatal pediatric visit.

4) Chapter 176A (new Section 8VV)
- Hospital service plans delivered in Massachusetts must cover a prenatal pediatric visit (subscriber/plan relationship).

5) Chapter 176B (new Section 4VV)
- Subscription certificates under medical service agreements delivered or renewed in Massachusetts must cover a prenatal pediatric visit.

6) Chapter 176G (new Section 4NN)
- Health maintenance contracts must provide coverage for a prenatal pediatric visit.

Who is affected

  • Pregnant individuals in Massachusetts and their families.
  • Insurers and health plan issuers (public and private) including:
    • Commonwealth group insurance plans
    • Medicaid managed care organizations and related contractors
    • Commercial medical, hospital service, and health maintenance plans
  • Medical providers, especially pediatricians, who may participate in prenatal outreach or consultations with pregnant patients.
  • State agencies responsible for health coverage oversight and member communications.

Procedural/timeline aspects

  • Introduced: February 27, 2025.
  • Legislative actions: Referred to the House Committee on Financial Services (same date as introduction).
  • Senate concurrence noted (status reflects cross-chamber activity).
  • Hearing scheduled: October 8, 2025, from 10:30 AM to 2:30 PM, Gardner Auditorium.
  • The bill’s docket number is 1268; it is related to House Docket 963.
  • No explicit funding mechanism or effective date is stated in the text provided; the bill focuses on mandate language for coverage and notice requirements.

Potential impact and considerations

  • Expands access to early maternal-pediatric collaboration by ensuring coverage for prenatal pediatric visits.
  • Could modestly increase insurer administrative duties (notice obligations) and potential short-term costs, balanced against potential long-term benefits in family health outcomes.
  • Aligns with AAP recommendations for early pediatric involvement in pregnancy contexts.
  • Implementation would require insurers to update marketing materials and policy language to reflect the new coverage requirement.

This summary captures the bill’s core aims, coverage scope, affected parties, and the current legislative status and timeline.

Compiled from official sources — confirm details with the bill’s official record.

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