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 trouble to reimburse the delivery staff.
However officers warned that each one non-obligatory Medicaid companies are nonetheless below evaluate because the state well being division seems for cuts to offset a shortfall pushed by higher-than-expected Medicaid prices.
Jon Ebelt, a spokesperson with the Montana Division of Public Well being and Human Companies, 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 will value the state about $118,000 in its first yr to supply doula Medicaid reimbursements, in response to state estimates.
His April 15 feedback got here three weeks after division officers informed KFF Well being Information 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 accredited in a invoice final yr. The protection is “now continuing as deliberate,” he stated.
“On the time of your preliminary inquiry, we had been nonetheless within the means 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. A minimum of 25 different states reimburse doulas via Medicaid.
Doulas are educated, nonmedical staff who assist folks via being pregnant and after they provide delivery. The care they supply is linked to reductions in well being problems, which has prompted extra states to cowl doula companies lately.
Montana lawmakers who supported increasing Medicaid to cowl doula care in 2025 cited scarce maternity companies, particularly in rural and Indigenous communities. However this yr, the state has a Medicaid funds deficit of greater than $177 million and is anticipating an identical shortfall subsequent yr. Plus, federal coverage modifications slated to take impact later this yr are anticipated to extend prices.
“ There’s a necessity and a want for doula companies, however lots of people can’t afford it,” stated Sheri Walker, a Helena-based doula and president of the Montana Doula Collaborative. “So meaning many people produce other jobs that we’ve got 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 electronic mail to KFF Well being Information that the company “is not going to be transferring ahead with the implementation of doula companies within the Montana Medicaid profit bundle at the moment.” She had added that it was unclear whether or not state regulation provides 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 Well being Information’ reporting. Neumann stated she and teams that had backed the laws started calling well being officers, making the case for doula companies as a low-cost means to supply vital care.
After a few week, Neumann stated, state officers informed her the company was transferring forward with doula companies in spite of everything.
“They had been on the chopping block,” Neumann stated. “It is a story of how necessary it’s for all Montanans to concentrate and keep linked to what’s taking place.”
Ebelt didn’t make clear what led the division to vary its place. Nevertheless, he warned that non-obligatory Medicaid companies, equivalent to doula companies, should be minimize.
“All non-obligatory companies, together with this service, are being reviewed,” Ebelt stated, referring to doula care. He didn’t reply to a follow-up question as as to whether the division would possibly nonetheless resolve to postpone this system following federal approval.
Elective companies are varieties of care that states select to cowl via their Medicaid packages however aren’t required by federal regulation. That may embrace overlaying eyeglasses, pharmaceuticals, and prosthetics, and extra specialised care equivalent to bodily remedy, or inpatient psychiatric companies for folks below 21.
These companies might not sound non-obligatory, stated Liz Williams, who research Medicaid financing at KFF, a well being info nonprofit that features KFF Well being Information. However she stated they’re one of many few avenues states should make changes when budgets get tight.
Congressional Republicans’ One Large Lovely Invoice Act, the spending measure President Donald Trump signed into regulation final July, is anticipated to place extra states in a funds crunch as its provisions begin to take impact by the top of the yr. The federal authorities has estimated that the regulation will cut back federal Medicaid spending by almost $1 trillion over 10 years. The regulation additionally left states with a better share of the prices to supply meals help.
Williams stated many states expanded companies lately by boosting non-obligatory Medicaid advantages and supplier pay.
“We may see them stroll these again,” Williams stated.
Montana’s monetary issues preceded federal modifications. Final yr, state lawmakers minimize 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.
Well being officers should define a plan to chop prices earlier than the state’s 2027 funds yr begins on July 1. Concurrently, 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 brand new guidelines, mandated via long-delayed state laws and the federal spending regulation, can have a three-month grace interval.
Stephanie Morton, government director of Wholesome Moms, Wholesome Infants-The Montana Coalition, stated she’s grateful the state is again on monitor to pay for doula companies via Medicaid. However she stated she’s apprehensive about potential well being care cuts to return.
“We all know that doulas are a vital piece of that infrastructure, however standing alone and shedding different sources of care actually isn’t optimum,” Morton stated. “These should not sturdy programs because it stands.”
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