Montana officers stated they’re transferring ahead with plans to permit Medicaid to pay doulas, reversing a earlier assertion that funds issues had prompted them to pause the hassle to reimburse the start employees.
But officers warned that every one non-compulsory Medicaid providers are nonetheless underneath assessment because the state well being division appears for cuts to offset a shortfall pushed by higher-than-expected Medicaid prices.
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Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, stated the company is making ready a request to the federal authorities so as to add doula care to the state’s Medicaid program. It would value the state about $118,000 in its first yr to supply doula Medicaid reimbursements, in line with state estimates.
His April 15 feedback got here three weeks after division officers told KFF Health News that the state funds deficit had put these plans on maintain. Ebelt denied {that a} last resolution had been made in March to scrap the doula Medicaid funds, which state lawmakers authorized in a invoice final yr. The protection is “now proceeding as planned,” he stated.
“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt stated.
Federal well being officers should approve any amendments to the state’s Medicaid program earlier than funds can start. At least 25 other states reimburse doulas by way of Medicaid.
Doulas are educated, nonmedical employees who assist folks by way of being pregnant and after they provide start. The care they supply is linked to reductions in well being issues, which has prompted more states to cover doula providers in recent times.
Montana lawmakers who supported increasing Medicaid to cowl doula care in 2025 cited scarce maternity providers, particularly in rural and Indigenous communities. But this yr, the state has a Medicaid funds deficit of greater than $177 million and is anticipating an analogous shortfall subsequent yr. Plus, federal coverage modifications slated to take impact later this yr are anticipated to extend prices.
“ There’s a need and a desire for doula services, but a lot of people can’t afford it,” stated Sheri Walker, a Helena-based doula and president of the Montana Doula Collaborative. “So that means many of us have other jobs that we have to juggle.”
Walker is a part-time labor and supply nurse exterior of her doula work.
On March 25, well being division spokesperson Holly Matkin stated in an e-mail to KFF Health News that the company “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” She had added that it was unclear whether or not state legislation offers the division the authority to authorize protection through the funds shortfall.
State Sen. Cora Neumann, a Democrat who sponsored final yr’s bipartisan doula reimbursement invoice, stated she didn’t know in regards to the division’s plans till she noticed KFF Health News’ reporting. Neumann stated she and teams that had backed the laws started calling well being officers, making the case for doula providers as a low-cost approach to supply important care.
After a few week, Neumann stated, state officers instructed her the company was transferring forward with doula providers in spite of everything.
“They were on the chopping block,” Neumann stated. “This is a story of how important it is for all Montanans to pay attention and stay connected to what’s happening.”
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Ebelt didn’t make clear what led the division to vary its place. However, he warned that non-compulsory Medicaid providers, reminiscent of doula providers, should still be lower.
“All optional services, including this service, are being reviewed,” Ebelt stated, referring to doula care. He didn’t reply to a follow-up question as as to if the division may nonetheless resolve to postpone this system following federal approval.
Optional services are forms of care that states select to cowl by way of their Medicaid applications however aren’t required by federal legislation. That can embrace protecting eyeglasses, prescribed drugs, and prosthetics, and extra specialised care reminiscent of bodily remedy, or inpatient psychiatric providers for folks underneath 21.
Those providers might not sound non-compulsory, stated Liz Williams, who research Medicaid financing at KFF, a well being info nonprofit that features KFF Health News. But she stated they’re one of many few avenues states should make changes when budgets get tight.
Congressional Republicans’ One Big Beautiful Bill Act, the spending measure President Donald Trump signed into law last July, is expected to put more states in a budget crunch as its provisions start to take effect by the end of the year. The federal government has estimated that the law will reduce federal Medicaid spending by nearly $1 trillion over 10 years. The law also left states with a higher share of the costs to provide food assistance.
Williams stated many states expanded providers in recent times by boosting non-compulsory Medicaid advantages and supplier pay.
“We could see them walk those back,” Williams stated.
Montana’s monetary issues preceded federal modifications. Last yr, state lawmakers lower a few of the well being division’s funding and underestimated Medicaid use. The state additionally overestimated what the federal authorities would pay towards Montana’s Medicaid prices.
Health officers should define a plan to chop prices earlier than the state’s 2027 funds yr begins on July 1. Simultaneously, the company is making an attempt to rent extra staffers to start vetting whether or not Medicaid enrollees meet or are exempt from new work necessities that additionally go in place July 1. The new guidelines, mandated by way of long-delayed state laws and the federal spending legislation, may have a three-month grace interval.
Stephanie Morton, government director of Healthy Mothers, Healthy Babies-The Montana Coalition, stated she’s grateful the state is again on monitor to pay for doula providers by way of Medicaid. But she stated she’s frightened about potential well being care cuts to return.
“We know that doulas are a critical piece of that infrastructure, but standing alone and losing other sources of care really isn’t optimal,” Morton stated. “These are not robust systems as it stands.”
