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HB 4704

Human services: medical services; coverage for group prenatal care services; require. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 109t.

2025-2026 Regular Session Introduced by Timmy Beson and 21 co-sponsors

Michigan requires private insurance starting 2026 and Medicaid to cover group prenatal care, a group-based model with education, support, and peer interaction to expand access.

re-referred to Committee on Insurance
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Bill Summary · HB 4704

HB 4704 – Comprehensive Summary

Purpose and intent

  • To expand access to prenatal care by requiring group prenatal care services to be covered in Michigan.
  • HB 4704, together with its companion HB 4703, aims to codify group prenatal care as a covered service under both private health insurance and the state’s Medicaid program.
  • The policy emphasizes an evidence-based group model that combines medical care with education, social and clinical support, and peer-to-peer interaction.

What the bill would do

HB 4703 (Insurance Code amendment)

  • Amends the Insurance Code (proposed MCL 500.3406ss) to require that any health insurance policy delivered, issued, or renewed in Michigan on or after January 1, 2026 include coverage for group prenatal care services.
  • Defines “group prenatal care services” as a series of prenatal visits in a group setting based on an evidence-based model, including:
    • Health assessments by a qualified provider
    • Social and clinical support
    • Educational activities in a family-centered environment
    • Peer-to-peer interaction among pregnant individuals
  • Enforcement and penalties:
    • Violations may be subject to a civil fine (up to $1,000 per violation; $5,000 if the violator knew or reasonably should have known of the violation)
    • Civil fines capped at $50,000; collected revenue deposited to the state General Fund
    • Violations may be reviewed through an administrative hearing before the Director of the Department of Insurance and Financial Services (DIFS)
  • Fiscal impact (as analyzed):
    • No direct state/local government cost anticipated
    • Potential additional revenue for the General Fund from penalties
    • Administrative costs may be borne by DIFS; not expected to be substantial
  • Existing framework notes:
    • Group prenatal care is described as an evidence-based model that may include the services listed above

HB 4704 (Social Welfare Act amendment)

  • Amends the Social Welfare Act (proposed MCL 400.109t) to require Michigan’s Medicaid program to cover group prenatal care services using the same evidence-based group model described above.
  • Defines the coverage and model similarly to HB 4703.

Who/what is affected

  • Private health insurance policyholders in Michigan (policies delivered, issued, or renewed on or after Jan 1, 2026)
  • Michigan residents enrolled in Medicaid (DHHS) who would access group prenatal care services
  • Healthcare providers offering prenatal care in a group setting (potential changes in reimbursement and participation)
  • State enforcement and regulatory agencies (DIFS) and DHHS

Implementation timeline and procedural notes

  • Effective dates:
    • Insurance coverage requirement: policies delivered/issued/renewed on or after January 1, 2026
    • Medicaid coverage requirement: take effect upon the amendatory act’s effective date adding Sec. 109t
  • Legislative status and actions:
    • Introduced: March 12, 2025
    • Referred to Committee on Insurance
    • Status as of June 26, 2025: electronically reproduced; HB 4704 introduced by Rep. Wortz with several cosponsors
  • Related legislation:
    • Companion bill SB 237 (Senate)

Fiscal impact (highlights)

  • Private insurance:
    • No direct state/local government costs anticipated
    • Possible penalties under Section 150 of the Insurance Code could generate General Fund revenue if violations occur
  • Medicaid (DHHS):
    • Indeterminate but nonsubstantive administrative costs for DHHS
    • Potential increased Medicaid costs due to expanded coverage, provider participation, and utilization
    • Reimbursable costs could receive FMAP funding; for FY 2025-26 Michigan’s FMAP is 65.30%
    • Existing appropriation: $5.0 million gross allocated in the annual appropriations act for hospital-based group prenatal services (may be affected by codification)

Summary of the substantive change

  • Codifies the requirement that private health insurance policies cover group prenatal care services starting in 2026.
  • Urges/mandates Medicaid to cover the same group prenatal care services, expanding access to a group-based prenatal model within public insurance.
  • Establishes a clear definition of group prenatal care and aligns private and public coverage around this model.
  • Sets enforcement mechanisms and notes potential fiscal considerations, including federal matching funds and existing program appropriations.

Notes

  • House Fiscal Agency analysis indicates potential administrative costs for DHHS are indeterminate but non-substantive; Medicaid-related costs depend on provider participation and utilization, offset to some extent by FMAP.
  • Companion bill: SB 237.

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

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