The Kira Johnson Act directs the Department of Health and Human Services to fund community-based organizations, develop respectful-maternity-care training for the entire maternity workforce, commission a study on bias-reduction programs, and seed hospital-level compliance programs to identify and respond to racism or bias in maternity care. The bill pairs multi-year grant authorizations with technical assistance and reporting requirements intended to center culturally and linguistically congruent, trauma-informed approaches.
This is a structural intervention: it channels recurring federal dollars into local nonprofits, invests modestly in workforce training, and creates reporting and evaluation mechanisms at hospital and federal levels. For health systems and compliance officers, the bill creates new grant opportunities and anticipated reporting burdens; for CBOs and midwifery programs it creates direct funding pathways and prioritization rules tied to community representation and evidence-based practices.
At a Glance
What It Does
The Act authorizes $100 million per year (FY2027–2031) for grants to community-based organizations and $5 million per year (FY2027–2031) for respectful-maternity-care training grants, requires a 1-year outreach/technical-assistance period before awarding community grants, and funds hospital-level compliance program grants and federal studies and reports. It also tasks HHS to develop application assistance, collect program-level reports, and disseminate best practices.
Who It Affects
Direct recipients include community-based maternal health organizations, midwifery practices, hospitals and health systems that provide maternity care, historically Black colleges or universities and other minority-serving institutions that design programs, and the full range of maternity workforce members — clinical and nonclinical. HHS, the National Academies, and the Government Accountability Office also receive specific roles.
Why It Matters
The bill prioritizes funding for organizations led by or serving demographic groups with elevated maternal risks and requires hospitals to institutionalize patient-reporting and public transparency about bias and patient experience. By combining community funding, workforce training, and compliance/reporting mechanisms, it aims to change both where services are delivered and how care teams are trained and held accountable.
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What This Bill Actually Does
Section 2 establishes a dedicated grant stream to community-based organizations that provide services aligned with evidence-based maternal health practices, with an emphasis on groups serving populations with elevated maternal mortality or severe maternal morbidity. HHS must spend the first year after enactment doing outreach and providing technical assistance to diversify the applicant pool; grants may support a wide range of community interventions including group prenatal/postpartum care, perinatal health worker programs, midwifery practice expansion, maternal mental health and substance-use supports, and activities addressing social determinants of health.
The statute includes special consideration criteria — for example, favoring organizations based in high-need communities, led by people from affected demographic groups, or offering culturally and linguistically congruent services — and requires an evaluation to Congress by the end of FY2031. Funding is explicitly authorized at $100 million per year for FY2027–2031.
The bill adds a new section to the Public Health Service Act to create grant programs for "respectful maternity care" training. That program emphasizes ongoing (not just one-time) education, includes nonclinical staff (reception, security, schedulers, sonographers) as training targets, and prioritizes trainings tied to continuing education units and integration into undergraduate health pipelines.
Grant applicants that incorporate trauma-informed care, implicit-bias and antiracism content, and delivery in WIC or similar settings receive preference. Recipients must report annually on activities and impacts, and HHS will compile best-practice reports for public dissemination.
This training stream carries a separate authorization of $5 million per year for FY2027–2031.Section 4 directs HHS to contract with the National Academies within 90 days to study and recommend evaluation standards and training frequency/type that demonstrably improve outcomes for pregnant and postpartum people from racial and ethnic minority groups; the Academies must complete that work and report to Congress within 24 months. Separately, Section 5 funds grants to hospitals and birth settings to implement respectful maternity care compliance programs.
Those compliance programs must create patient- and worker-facing reporting mechanisms for incidents of racism or bias, commit to timely follow-up, publish a hospital-wide strategy that includes training inventories and case counts, collect patient-experience data, and submit annual deidentified case reports to HHS with demographic and outcome-related information.Finally, the Act builds in federal oversight: HHS must establish processes to share best practices within 180 days, contract an independent study on implementation and accountability within two years, and the GAO must report to Congress starting two years after enactment and annually thereafter on program uptake, geographic and facility-level gaps, and whether available funding has been sufficient. Some grant authorities are fixed-dollar authorizations (community grants and training), while the compliance program funding is "as may be necessary" for FY2027–2032, leaving final appropriations to future budget decisions.
The Five Things You Need to Know
The community-based grant program is authorized at $100 million per year for FY2027–2031 and requires a 1-year outreach and technical-assistance window before HHS begins awards.
Respectful-maternity-care training grants are authorized at $5 million per year for FY2027–2031 and must prioritize periodic, CEU-capable training that includes all staff who interact with pregnant or postpartum individuals (clinical and nonclinical).
HHS must seek an agreement with the National Academies within 90 days and receive a completed study and report within 24 months on evaluation standards and the types/frequency of bias-reduction training demonstrated to improve outcomes.
Hospital/health-system respectful-maternity-care compliance programs funded by grants must institute patient and worker reporting channels for racism or bias, publicly post a strategy and case counts, collect patient-experience measures, and send annual deidentified case reports to HHS detailing demographics, reports, responses, and institutional changes.
The Comptroller General must deliver a GAO report beginning two years after enactment and annually thereafter that catalogs which facilities set up compliance programs, where programs are absent, impacts observed, and whether funding was sufficient.
Section-by-Section Breakdown
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Sustained grants to community-based organizations
This section requires HHS to award grants to community organizations that run programs aligned with evidence-based maternal health practices for populations with elevated maternal risks. HHS must spend the first year doing outreach and technical assistance to help prospective applicants, and give special consideration to organizations based in high-need communities, led by members of affected groups, or offering culturally and linguistically congruent services. The provision lists eligible activities (from perinatal worker supports and group prenatal care to midwifery practice investments and mutual aid around infant formula shortages) and mandates an evaluation to Congress by the end of FY2031; the program is explicitly funded at $100 million annually for FY2027–2031.
Grants for respectful maternity care training across the workforce
The bill inserts a new Public Health Service Act section creating grant funding for programs that reduce bias, racism, and discrimination and promote trauma-informed, culturally and linguistically congruent care. Applicants that propose periodic trainings (not single events), integrate content into continuing-education pathways, cover nonclinical staff, include antiracism and implicit-bias work, or are developed by HBCUs/MSIs receive special consideration. Grant recipients must report annually on training activities and impacts; HHS will aggregate findings and publish best practices. This is a targeted, modestly funded stream ($5 million per year) intended to change workforce norms and training delivery.
National Academies study on bias-reduction programs
HHS must negotiate an agreement with the National Academies within 90 days to study program design and implementation for reducing bias and to recommend evaluation metrics and training standards. The Academies must finish the work and report to Congress within 24 months. The statute identifies possible study topics such as a scorecard for program effectiveness and the proven frequency/type of trainings, giving future grant-makers and hospitals a technical foundation for measuring impact.
Respectful maternity care compliance program grants for hospitals and birth settings
This section funds grants to accredited hospitals and birth settings to integrate respectful maternity care compliance programs into quality initiatives. Funded programs must create mechanisms for patients, families, and perinatal workers to report perceived racism or bias, provide timely follow-up, publish a hospital-wide strategy (including the number of reported cases and the training inventory), routinely measure patient experience, and submit annual deidentified reports to HHS containing demographics, report content, responses, and institutional changes. HHS must issue dissemination processes within 180 days and commission an independent study—via contract—on implementation and accountability within two years, with recommendations for potential accountability mechanisms.
GAO reporting requirements
The Comptroller General must produce a report no later than two years after enactment and then annually, documenting which hospitals and birth settings have adopted respectful maternity care compliance programs, where programs are absent and why, the observed impacts on outcomes and experiences (to the extent practicable), and whether allocated funding has been sufficient. The GAO report is intended to provide Congress with program uptake and gaps at a national level and to inform future appropriations or statutory adjustments.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Community-based maternal health organizations: The bill creates a stable, multi-year federal funding channel and technical assistance designed to expand community-delivered services (group prenatal/postpartum care, perinatal worker programs, maternal mental health services) that are tailored to populations most affected by disparities.
- Pregnant and postpartum individuals from racial and ethnic minority groups: The combination of community funding, workforce training, and hospital compliance programs aims to increase culturally and linguistically congruent care, reduce incidents of bias, and improve patient-reported experience and outcomes.
- Midwifery practices and midwives: The statute explicitly lists midwifery practice expansion, education supports, and preceptor training as eligible uses, opening funding for clinical site investments, tuition/debt supports, distance learning, and practice expansion—especially for practices serving communities of color.
- Perinatal health workers and nonclinical staff: Training grants target the entire maternity workforce (including front desk, security, sonographers), potentially improving workplace competencies, job supports, and the quality of patient interactions for marginalized patients.
- Historically Black colleges and universities and other MSIs: HBCUs and MSIs that design curricula or programs receive special consideration for training grants, which can strengthen institutional partnerships and pipeline programs into health professions.
Who Bears the Cost
- Department of Health and Human Services: HHS must administer outreach, technical assistance, grant competitions, reporting systems, program evaluations, contracts with the National Academies and independent researchers, and ongoing dissemination activities—requiring staffing and administrative capacity.
- Hospitals and health systems: Institutions that accept compliance grants (or choose to participate) must build reporting channels, maintain follow-up workflows, collect and publicly post data and strategies, and file annual deidentified reports—creating operational costs and potential reallocation of quality resources.
- Small and rural maternal care providers: Smaller hospitals and clinics may face disproportionate burdens to implement compliance mechanisms and training if they must match grant activities administratively or if grant funding does not fully cover costs.
- Federal taxpayers and appropriators: The bill commits fixed authorizations for some streams ($100M and $5M annually for specified years) and open-ended funding for compliance program rollout, leaving appropriators to fund the overall strategy in future budget cycles.
- Community-based organizations applying for grants: Organizations will need capacity to prepare competitive applications and comply with reporting/evaluation requirements, which may require upfront investments in grant-writing, data systems, or partnerships.
Key Issues
The Core Tension
The core dilemma is balancing accountability and improvement with trust and community leadership: the bill simultaneously centralizes oversight (reporting, federal studies, GAO surveillance) to drive measurable reductions in racialized harms, while aiming to empower community-led, culturally congruent services; the harder question is how to impose measurement and oversight without displacing or bureaucratizing the community practices the funding is meant to bolster.
The Act combines community-led investment with top-down accountability, but several implementation questions could blunt impact. First, the bill repeatedly references "evidence-based practices" and the need to assess effectiveness, yet leaves the technical definition and the threshold of evidence to HHS and the National Academies' subsequent work.
That sequencing means early grant rounds could fund heterogeneous models whose comparability and cumulative effects will be difficult to evaluate. Second, the required data collection — deidentified demographic detail, patient-reported experiences, and counts of bias reports — raises operational and privacy challenges.
Hospitals will need standard data definitions and interoperable reporting formats; without them, cross-site aggregation and national assessment (which the evaluation clauses seek) will be noisy and limited.
There are financial and sustainability trade-offs as well. Community grant funding is authorized for a fixed window (FY2027–2031); absent a plan for transitioning successful programs to other payors (Medicaid, private insurers, philanthropic sustainment), effective local models risk collapse after the authorization period.
Similarly, the bill's compliance program incentives could produce uneven uptake: well-resourced hospitals may implement robust systems, while resource-constrained facilities decline participation or adopt minimal, compliance-driven reporting that prioritizes box-checking over systemic change. Finally, the bill creates overlapping evaluation mechanisms (HHS evaluations, National Academies study, independent contracted studies, and GAO reports) that could duplicate effort unless coordinated, and it does not specify how findings will influence future grant criteria or enforcement actions.
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