This legislation seeks to bolster financial stability for rural and safety net hospitals offering maternity, labor, and delivery services, particularly for vulnerable populations. It mandates that States conduct studies every five years to assess the costs of providing these services in applicable hospitals, which include those in rural areas or with a high percentage of Medicaid/CHIP births. The Secretary of Health and Human Services (HHS) will then compile and report on these findings, with dedicated funding to assist small rural hospitals in data collection. A key provision requires Medicaid fee-for-service payments for maternity, labor, and delivery services at eligible hospitals to be at least 150% of Medicare rates starting in fiscal year 2027. Future payment rates will be adjusted to accurately reflect actual costs, informed by the State studies. This adequate payment requirement also extends to Medicaid managed care plans and the Children's Health Insurance Program (CHIP), ensuring comprehensive financial support. To further support essential services, the bill introduces "anchor payments" for low-volume obstetric hospitals , defined as eligible hospitals with fewer than 300 births annually. These payments will cover any shortfall if a hospital's Medicaid and CHIP revenue for labor and delivery services falls below a specified "revenue floor," which includes a per-delivery amount and a standby capacity amount to ensure readiness. Hospitals receiving these payments must commit to maintaining obstetric skills, continuing services, and utilizing funds specifically for labor and delivery care. Beyond financial support for hospitals, the legislation significantly expands maternal health coverage. It mandates 12-month continuous, full-benefit coverage under Medicaid and CHIP for pregnant and postpartum individuals, removing the previous State option. This ensures uninterrupted access to care during a critical period for maternal and infant health. States are also given the option to establish "maternity health homes" under Medicaid, which will provide comprehensive, coordinated care for pregnant and postpartum individuals, including behavioral health and social support services. These health homes will receive enhanced federal matching funds for their services. Additionally, HHS will issue guidance to States on how to support and improve Medicaid and CHIP coverage for services provided by doulas and other maternal health professionals , especially in rural and underserved areas. The bill increases federal financial participation for States that provide depression and anxiety screenings for pregnant and postpartum individuals, recognizing the importance of mental health during this period. It also makes presumptive eligibility for pregnant individuals under Medicaid mandatory for States, streamlining access to immediate care. These measures aim to ensure that more individuals receive timely and comprehensive maternal health services. To address workforce challenges, the bill expands the Public Health Service Act to allow the Commissioned Corps to respond to "urgent maternal health care needs," such as those arising from obstetric unit closures or workforce shortages. This includes detailing personnel to assist affected facilities and requiring plans for long-term staffing solutions. The legislation also authorizes significant annual funding for the Commissioned Corps to enhance its operations and training, including in maternal health care. Furthermore, the bill streamlines the enrollment process for out-of-state providers of maternity, labor, and delivery services into State Medicaid plans, facilitating access to care across State lines. This streamlined process applies to providers deemed low-risk for fraud and already screened by Medicare or a neighboring State's Medicaid program. Finally, the legislation enhances transparency by requiring hospitals to provide 180-day advance public notification of impending obstetric unit closures, including an impact analysis. Hospitals will also be required to submit detailed data on labor and delivery services, including birth numbers, transfers, staffing, expenses, and revenue, to improve understanding of obstetric care provision.