Why It Matters
Montana will proceed with plans to allow Medicaid reimbursement for doula services, reversing an earlier indication that budget constraints would delay the program. The decision affects access to birth support services for low-income pregnant women in a state facing rural maternity care shortages. However, state officials warned that all optional Medicaid services remain under review as the department seeks cuts to address a $177 million budget deficit.
What Happened
Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, said the agency is preparing a request to federal officials to add doula care to the state’s Medicaid program. The coverage was approved by state lawmakers last year and is estimated to cost Montana approximately $118,000 in its first year.
In late March, department officials had stated the program was on hold due to the state’s Medicaid budget shortfall. Ebelt denied that a final decision to scrap the payments had been made, saying the agency was still analyzing the appropriation at that time. Federal approval is required before any Medicaid program amendments can take effect.
Doulas are trained, nonmedical workers who provide support during pregnancy and after childbirth. Research links their services to reductions in health complications during delivery.
By the Numbers
Montana faces a Medicaid budget deficit exceeding $177 million this year, with a similar shortfall projected for next year. At least 25 other states currently reimburse doulas through Medicaid. The doula reimbursement program would cost the state about $118,000 annually in its initial phase. Federal policy changes under the One Big Beautiful Bill Act are expected to reduce federal Medicaid spending by nearly $1 trillion over 10 years, increasing state budget pressures.
Political Response
State Senator Cora Neumann, a Democrat who sponsored the bipartisan doula reimbursement legislation, said she learned of the department’s initial decision to pause the program through news reporting. Neumann said she and advocacy groups contacted health officials to argue that doula services represent a low-cost approach to addressing maternity care gaps. After approximately one week, state officials informed her the agency would proceed with the program.
Ebelt warned that optional Medicaid services, including doula coverage, remain subject to review. Optional services are benefits states may choose to cover but are not federally mandated. They include prescription drugs, eyeglasses, physical therapy, and inpatient psychiatric services for individuals under 21.
Zoom Out
More states have expanded Medicaid coverage for doula services in recent years as policymakers seek to address maternal health outcomes and access barriers in underserved communities. Montana lawmakers cited scarce maternity services in rural and Indigenous areas when approving the coverage expansion.
Federal spending legislation signed in July is expected to increase budget pressure on state Medicaid programs nationwide. The law shifts a higher share of food assistance costs to states and reduces federal Medicaid contributions, forcing states to consider cuts to optional services.
What’s Next
Montana must submit its request to federal health officials and receive approval before Medicaid payments to doulas can begin. The state health department will continue reviewing optional Medicaid services as it identifies cuts to address the budget shortfall. Officials have not ruled out future delays to the doula program depending on budget conditions.