Montana Moves Forward With Medicaid Doula Coverage But Budget Pressures Put Optional Services at Risk
Why It Matters
Montana’s decision to proceed with Medicaid reimbursement for doula services offers a lifeline to expectant mothers in rural and Indigenous communities where maternity care is scarce — but the program’s long-term survival is far from guaranteed. The state faces a Medicaid budget deficit exceeding $177 million, and officials have made clear that all optional Medicaid services remain on the table for cuts.
The situation highlights the growing tension between state-level efforts to expand maternal health support and the financial strain now hitting Medicaid programs across the country, including pressures stemming from federal spending changes.
What Happened
Montana health officials confirmed in mid-April that the state is moving forward with a plan to add doula care to its Medicaid program — reversing what appeared to be an earlier decision to shelve the effort. Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, said the agency is preparing a formal request to federal health officials to amend the state’s Medicaid program to include doula coverage.
The reversal came after a March 25 email from a separate department spokesperson stated that Montana “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” State Sen. Cora Neumann, a Democrat who sponsored the bipartisan doula reimbursement legislation passed by state lawmakers, said she was unaware of the department’s initial pause until news reports surfaced. She and advocacy groups then contacted health officials to make the case for reinstating the program.
“They were on the chopping block,” Neumann said. “This is a story of how important it is for all Montanans to pay attention and stay connected to what’s happening.”
Ebelt confirmed coverage is “now proceeding as planned,” but offered no explanation for what prompted the department’s shift in position. He did caution that the program — like all optional Medicaid services — remains under active review as the department searches for ways to close its budget gap.
By the Numbers
$118,000 — Estimated first-year cost to the state of adding doula Medicaid reimbursements, according to state figures.
$177 million+ — Montana’s current Medicaid budget deficit, with a similar shortfall anticipated in the following year.
25 states — The number of states that already reimburse doulas through Medicaid, placing Montana among a growing but not universal group.
Nearly $1 trillion — The estimated reduction in federal Medicaid spending over 10 years under the federal spending law signed by President Trump, which is expected to increase cost pressures on states beginning later this year.
July 1 — The deadline by which Montana health officials must outline a plan to reduce Medicaid costs before the state’s 2027 budget year begins.
Zoom Out
Montana’s budget strain is part of a national pattern. Many states expanded optional Medicaid benefits in recent years as enrollment and federal support grew. Now, with federal Medicaid funding set to decline under recently enacted federal law, states face difficult choices about which optional services to preserve. New Jersey is grappling with similar Medicaid-related pressures, where looming federal cuts are already raising alarms about access to services for vulnerable populations.
Doula care has gained traction nationally as evidence mounts that birth support workers reduce health complications, particularly in underserved communities. At least 25 states now cover doula services through Medicaid, a number that has grown steadily in recent years as maternal health outcomes — especially in rural and minority communities — have drawn increased policy attention.
Sheri Walker, a Helena-based doula and president of the Montana Doula Collaborative, noted the financial barriers that prevent many families from accessing care privately. “There’s a need and a desire for doula services, but a lot of people can’t afford it,” Walker said. “So that means many of us have other jobs that we have to juggle.”
What’s Next
Before any Medicaid payments for doula services can begin in Montana, the federal government must approve the state’s amendment request — a process that adds an additional layer of uncertainty to the timeline. Meanwhile, Montana’s health department must simultaneously develop a cost-reduction plan ahead of the July 1 budget deadline and begin implementing new Medicaid work requirements, which carry a three-month grace period upon taking effect.
Officials have not ruled out revisiting the doula program even after federal approval. Ebelt declined to answer whether the department might still postpone or reverse course following that approval. Advocates and lawmakers who pushed to restore the program say they will continue monitoring the situation closely.
The state’s broader fiscal challenges — compounded by expected federal Medicaid reductions — mean that Montana’s optional services, including doula coverage, could face renewed scrutiny before the end of the year. For context on how state agencies are navigating financial and legal pressures simultaneously, see the recent court order involving Montana’s Commerce Department director.