Montana Advances Medicaid Doula Reimbursement Despite Budget Concerns

Montana officials are moving forward with plans to allow Medicaid to reimburse doulas for birth support services, reversing an earlier decision to pause the effort due to budget constraints.

Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services, confirmed the agency is preparing a request to the federal government to add doula care to the state’s Medicaid program. The estimated first-year cost for reimbursements is approximately $118,000, according to state projections.

Ebelt’s remarks on April 15 followed a March 25 statement from department officials to KFF Health News, which suggested budget problems had halted the initiative. Ebelt denied that a final decision was made in March to scrap the payments, which were approved by state lawmakers in 2023.

“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt said. Federal approval is required before payments can begin.

At least 25 other states currently reimburse doulas through Medicaid. Doulas provide nonmedical support during and after pregnancy, and research links their services to reduced health complications, driving more states to adopt coverage in recent years.

Montana lawmakers who backed the 2023 legislation expanding Medicaid to include doula care cited limited maternity services, particularly in rural and Indigenous communities. However, the state now faces a Medicaid budget deficit exceeding $177 million this year, with similar shortfalls projected for 2025. Additional federal policy changes later this year are expected to further strain the budget.

“There’s a need and a desire for doula services, but a lot of people can’t afford it,” said Sheri Walker, a Helena-based doula and president of the Montana Doula Collaborative. Walker balances doula work with a part-time role as a labor and delivery nurse. “So that means many of us have other jobs that we have to juggle.”

On March 25, department spokesperson Holly Matkin told KFF Health News in an email that the agency “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” She also questioned whether the department had the authority to authorize coverage during the budget shortfall.

State Sen. Cora Neumann, a Democrat who sponsored last year’s bipartisan doula reimbursement bill, said she was unaware of the department’s plans until KFF Health News published its report. Neumann and advocacy groups then began lobbying health officials, arguing that doula services offer a cost-effective way to deliver critical care.