The Mental Health and Making Access More Affordable (MAMA) Act amends the Public Health Service Act, ERISA, and the Internal Revenue Code to require that group health plans and health insurance issuers that already cover mental health or substance use disorder (SUD) services stop imposing cost-sharing for those services from the diagnosis of pregnancy through the one-year period after the pregnancy ends. The prohibition applies to in-network care (including telehealth) and takes effect for plan years beginning two years after enactment.
For benefits managers, plan sponsors, and compliance officers this is a targeted, cross‑statute mandate: it does not create a new coverage requirement for plans that currently exclude mental health or SUD benefits, but it removes point-of-service financial barriers for pregnant and postpartum people where those benefits exist. The bill also updates continuity-of-care rules and extends the change into the Federal Employees Health Benefits Program (FEHBP) and the federal tax code’s treatment of employer plans, which spreads compliance obligations across commercial, self-funded, and federal plans.
At a Glance
What It Does
The bill bars in-network cost-sharing (copays, coinsurance, deductibles) for mental health and SUD services furnished from the diagnosis of pregnancy through one year postpartum when the plan/coverage already offers those benefits. Telehealth services are explicitly covered. The prohibition applies to group and individual market issuers, ERISA-covered group plans, and is reflected in the Internal Revenue Code and FEHBP.
Who It Affects
Affected entities include commercial insurers offering group or individual coverage that includes mental health/SUD benefits, self-funded employer plans governed by ERISA, FEHBP contractors, and the participants or enrollees who are pregnant or in the first postpartum year. Mental health and SUD clinicians who treat perinatal patients and telehealth vendors will see billing and authorization changes.
Why It Matters
The bill removes a common financial barrier during a high-risk clinical period, potentially increasing service use and stabilizing continuity of care. But it stops short of requiring plans to add mental health or SUD benefits if they don’t already have them, and it leaves several operational details — network adequacy, verification of pregnancy dates, and cross‑jurisdictional telehealth licensing — to regulators and plans to resolve.
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What This Bill Actually Does
S.3698 targets cost-sharing, not coverage mandates. It tells plans and issuers that if they provide mental health or SUD benefits, they cannot charge in-network copays, coinsurance, or apply deductibles for those services from the moment pregnancy is diagnosed until one year after the pregnancy ends.
That window is written to cover prenatal care, care during pregnancy, and an extended postpartum period that many clinicians identify as high-risk for new or worsening mental health and substance use conditions.
The bill inserts matching provisions into three legal frameworks so the rule reaches commercial insurers, ERISA-regulated plans (including self-funded employer plans), and the tax treatment of employer plans. It also amends FEHBP statutes so federal employee plans follow the same rule.
Telehealth is explicitly included as a covered service modality, which recognizes remote behavioral health care is part of perinatal treatment for many people.Separately, the legislation tweaks continuity-of-care language in the Public Health Service Act, ERISA, and the Internal Revenue Code so a patient who began treatment while pregnant can continue with the same provider into the postpartum year as a ‘‘continuing care patient’’ for purposes of prior authorization and transition protections. The bill does not alter out-of-network cost-sharing rules or force plans to cover out-of-network providers; its relief applies only to in-network services.Operationally, the effective date is a uniform two-year delay from enactment for plan years, giving plans time to amend contracts, update systems, and communicate changes to enrollees.
The statute delegates definitional work (for example, what counts as a ‘‘diagnosis of pregnancy’’) to the Secretary, so regulators will fill in timing and verification procedures. Enforcement pathways remain the existing ones under health statutes and ERISA; the bill creates no standalone enforcement office or new penalties beyond those already available under the amended statutes.
The Five Things You Need to Know
The prohibition on cost-sharing applies only if the plan or issuer already provides mental health or SUD benefits — the bill does not require plans to add those benefits.
Cost-sharing relief covers services furnished by in-network providers (including telehealth) from the diagnosis of pregnancy through the one-year period after the pregnancy ends.
The law becomes effective for plan years beginning on or after two years after enactment, giving plans a delayed implementation window.
The bill amends the Public Health Service Act, ERISA, and the Internal Revenue Code in parallel and extends the requirement to the Federal Employees Health Benefits Program.
Continuity-of-care rules are changed so patients who received mental health or SUD treatment while pregnant can continue with the same provider into the postpartum year as a continuing care patient.
Section-by-Section Breakdown
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Short title
Names the legislation the ‘‘Mental Health and Making Access More Affordable Act of 2026’’ or the ‘‘Mental Health and MAMA Act of 2026.’
No cost-sharing for in-network perinatal mental health and SUD care
Adds a new PHSA section that forbids group health plans and health insurance issuers from imposing cost-sharing for mental health or substance use disorder services furnished by in-network providers from the diagnosis of pregnancy through one year postpartum, including telehealth. The provision applies only where those benefits already exist; it does not expand mandatory benefit baskets. The Secretary is given the authority to define key terms such as ‘‘diagnosis of pregnancy.’
Extends continuing care protections into postpartum year
Modifies the PHSA continuity-of-care rules so that an individual who received mental health or SUD treatment while pregnant and whose pregnancy ended within the prior year qualifies as a continuing care patient. Practically, this affects prior authorization and transition protections — plans must honor certain ongoing courses of treatment from the same provider during that postpartum window.
Applies the cost-sharing ban to ERISA-governed group plans
Creates a mirror ERISA section that imposes the same no-cost-sharing requirement on group health plans subject to ERISA, including self-funded employer plans. It also changes ERISA’s continuity-of-care language in the same manner as the PHSA amendments. Because ERISA governs many employer-sponsored plans, this is the principal mechanism for reaching self-funded arrangements.
Incorporates the rule into the Internal Revenue Code
Adds an Internal Revenue Code provision to align tax treatment and plan qualification rules with the new cost-sharing standard, and updates the Code’s continuity-of-care text. Embedding the requirement in tax law reduces legal misalignment across statutes and supports consistent treatment for employer plans in regulatory and tax administration contexts.
Two-year delayed effective date for plan years
Sets the effective date to plan years beginning two years after enactment for the PHSA, ERISA, and IRC amendments. The two-year window allows issuers, plan sponsors, and third-party administrators to revise contracts, adjust formularies or networks if needed, and update claims systems.
Extends the requirement to federal employee plans
Amends FEHBP statutory cross-references so federal employee health plans, when entering or renewing contracts for plan years two years after enactment, must comply with the same no-cost-sharing requirement. This explicitly brings federal employees and annuitants within the law’s scope.
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Who Benefits
- Pregnant and postpartum people enrolled in affected plans — they face no in-network copays, coinsurance, or deductibles for mental health and SUD care from pregnancy diagnosis through one year postpartum, reducing financial barriers during a clinically sensitive period.
- Mental health and SUD clinicians treating perinatal patients — clearer coverage expectations and continuity protections may increase patient retention and reduce gaps in care when patients transition from pregnancy to postpartum treatment.
- Federal employees and their families under FEHBP — FEHBP amendments ensure federal enrollees receive the same in-network cost-sharing relief as commercial and ERISA plans once contracts renew under the effective date.
- Employers focused on maternal health outcomes and retention — removing point-of-care charges can support workforce health and may reduce downstream productivity losses related to untreated perinatal mental illness.
Who Bears the Cost
- Insurers and self-funded plan sponsors — eliminating point-of-service cost-sharing will likely raise plan expenditures for covered mental health and SUD services, which plans may offset through higher premiums or employer contributions.
- Plan administrators and benefits teams — they must change plan documents, claims systems, member communications, and provider contracts to implement the in-network no-cost-sharing rule and the expanded continuity-of-care mechanics.
- The federal government (FEHBP) — FEHBP carriers and the government as purchaser will face increased benefit costs for federal employees unless offset by appropriation or contract rate adjustments.
- Providers and telehealth vendors — while patient out-of-pocket costs decline, providers may face payment-rate negotiations, new billing rules, and prior authorization or utilization-review processes during the transition.
Key Issues
The Core Tension
The central dilemma is straightforward: expand immediate financial access to perinatal behavioral health care for those already covered, versus the practical and financial realities of plan budgets and provider supply. Removing point-of-care charges makes services more affordable for patients but increases plan costs and administrative complexity, and it may have limited effect where networks lack perinatal mental health capacity or where plans do not offer behavioral health benefits at all.
The bill solves a narrow affordability problem by removing cost-sharing, but leaves multiple operational and policy details unresolved. It applies only to in-network services where a plan already offers mental health or SUD benefits; it does not require plans to add those benefits.
That design reduces federal intrusion into benefit design but creates uneven coverage gaps: a patient with no in-network mental health benefit receives no relief under this statute. The text delegates definitional work (for example, what constitutes a ‘‘diagnosis of pregnancy’’ and how plans may verify pregnancy status) to the Secretary, which will make regulatory definitions consequential for eligibility windows and retrospective claims.
From an implementation perspective, the law reaches ERISA-covered and self-funded plans by adding a parallel ERISA provision, but ERISA enforcement often differs from state enforcement of insurance laws. The bill does not create new enforcement mechanisms or funding; agencies will enforce through existing statutory remedies and plan-exhaustion rules.
Telehealth inclusion removes modality barriers but does not address cross-state licensure, credentialing, or network adequacy if in-network behavioral health providers are scarce — removing cost-sharing does not create more clinicians. Finally, the two-year lag gives plans time to adjust but also delays access for current pregnant and postpartum enrollees; plan sponsors may respond by shifting costs elsewhere in benefit design or by narrowing networks.
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