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Bill

AB 1086

Relating to: reimbursement of maternal mental health screenings under the Medical Assistance program and coverage of maternal mental health screenings by health insurance policies and plans. (FE)

2025-2026 Regular Session Introduced by Margaret Arney and 11 co-sponsors

The bill requires Medicaid reimbursement for maternal mental health screenings and mandates private health plans to cover these screenings.

Failed to pass pursuant to Senate Joint Resolution 1
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WeVote Research Nonpartisan
Bill Summary · AB 1086

Summary of Assembly Bill 1086 (Session 2025, Wisconsin)

Overview

  • Bill Title: Relating to reimbursement of maternal mental health screenings under the Medical Assistance program and coverage of maternal mental health screenings by health insurance policies and plans.
  • Status (as of provided information): Introduced and referred to the Committee on Health, Aging and Long-Term Care. Co-authors and sponsors listed. No lobbying principals reported.
  • Primary aim: Ensure reimbursement for maternal mental health screenings under Wisconsin’s Medical Assistance program and require coverage of maternal mental health screenings by private health insurance policies and plans.

What the bill seeks to change

  1. Medicaid/Medical Assistance reimbursement

    • Establish or clarify reimbursement mechanisms for maternal mental health screenings under Wisconsin’s Medical Assistance program (Medicaid equivalent in Wisconsin).
    • Ensure providers administering maternal mental health screenings can be reimbursed, potentially increasing access to screening services for pregnant and postpartum individuals who are enrolled in Medicaid.

  2. Private health insurance coverage

    • Require health insurance policies and plans to cover maternal mental health screenings.
    • Align coverage with preventive care practices, reducing or eliminating cost barriers for individuals seeking screening during pregnancy and the postpartum period.

Who would be affected

  • Medicaid beneficiaries and providers:
    • Pregnant individuals, postpartum individuals, and other beneficiaries who would be eligible for maternal mental health screenings under Medicaid.
    • Healthcare providers who offer maternal mental health screenings, who would be reimbursed under the Medical Assistance program.
  • Private health insurance enrollees:
    • Individuals enrolled in health insurance policies/plans subject to Wisconsin law would gain coverage for maternal mental health screenings, subject to any policy-specific terms.
  • Insurers and payers:
    • Health insurers (private plans) and the state's Medicaid program would be responsible for implementing coverage/reimbursement provisions.

Key provisions and changes (inference based on title and fiscal notes)

  • Reimbursement framework under Medicaid:
    • Establish or specify reimbursement rates and procedures for maternal mental health screenings performed in clinical and possibly community settings.
    • Ensure screenings qualify for Medicaid payment, potentially with fasting or timing considerations similar to other preventive services.
  • Coverage mandate for private plans:
    • Require coverage for maternal mental health screenings with minimal or no cost-sharing (e.g., co-pays/deductibles) consistent with preventive services.
    • Specify that screenings are covered without being tied to disability or illness diagnoses, promoting preventive care.
  • Meaningful access considerations:
    • Promote access to screening across settings (OB/GYN, primary care, maternal health clinics) and demographic groups with higher risk of perinatal mood and anxiety disorders.
  • Effective date and phase-in:
    • Bills often include an implementation timeline (e.g., upon passage, with phased compliance for private plans within a specified period). The exact dates are not provided in the summary materials here, but there is typically a schedule for insurers to come into compliance.
  • Regulatory alignment:
    • Align with state Medicaid program rules and health insurance regulations to ensure uniform application across public and private coverage.

Timeline and procedural notes

  • Introduced: February 26, 2026
  • Committee action: Read first time and referred to Committee on Health, Aging and Long-Term Care (as of the record).
  • Sponsors: A broad coalition of representatives and senators, with multiple co-sponsors.
  • Current status highlights: No reported lobbying principals or lobbying activity on this bill in the provided records.

Potential impacts and considerations

  • Public health impact: Increased screening for maternal mental health could lead to earlier identification and treatment of perinatal mood and anxiety disorders, improving outcomes for mothers and children.
  • Access and affordability: By guaranteeing Medicaid reimbursement and private plan coverage, financial barriers to screening could be reduced.
  • Administrative considerations: Insurers and the Medicaid program would need to integrate billing codes, determine coverage parameters, and educate providers and beneficiaries about new benefits.
  • Equity considerations: Focus on expanding access across diverse populations, including underinsured or Medicaid-only populations.

What to monitor

  • The exact language of the bill regarding:
    • Scope of screenings covered (e.g., standardized screening tools like Edinburgh Postnatal Depression Scale or other validated instruments).
    • Timing (prenatal, postpartum, and well-child periods).
    • Cost-sharing limits and any exemptions.
    • Implementation dates for Medicaid reimbursement changes and private plan compliance.
  • Any amendments refinining reimbursement rates, eligible providers, or carve-outs.

If you’d like, I can tailor this summary to a specific audience (e.g., policymakers, healthcare providers, or the general public) or add a comparison with current Wisconsin law on maternal mental health screening.

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

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