Montana Revives Medicaid Doula Reimbursement Plans Amid Budget Concerns

Montana officials confirmed they are advancing plans to allow Medicaid to reimburse doulas, reversing an earlier decision to pause the initiative due to budget concerns. The move follows weeks of uncertainty after state health department officials indicated budget problems had halted the effort.

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

Ebelt’s remarks on April 15 came three weeks after department officials told KFF Health News that a state budget deficit had forced a temporary halt to the plans. He denied that a final decision was made in March to cancel Medicaid doula payments, which were authorized by state lawmakers in a bill passed last year. The coverage is now proceeding as planned, Ebelt said.

“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt stated.

Federal approval is required before Medicaid reimbursements for doulas can begin. Currently, at least 25 other states reimburse doulas through their Medicaid programs. Doulas are nonmedical professionals trained to support individuals during pregnancy and postpartum periods. Research links doula care to reduced health complications, contributing to its growing adoption by states.

Montana lawmakers who backed the 2025 doula Medicaid expansion cited limited maternity care access, particularly in rural and Indigenous communities. However, the state now faces a Medicaid budget deficit exceeding $177 million, with similar shortfalls projected for the next fiscal year. Federal policy changes later in 2024 are also expected to increase costs further.

“There’s a need and a desire for doula services, but a lot of people can’t afford it. So that means many of us have other jobs that we have to juggle.”

Sheri Walker, a Helena-based doula and president of the Montana Doula Collaborative, emphasized the financial barriers families face in accessing doula care. Walker, who works part-time as a labor and delivery nurse in addition to her doula practice, highlighted the strain on providers who rely on multiple income sources.

On March 25, health department spokesperson Holly Matkin sent an email to KFF Health News stating 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 legal 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 reading KFF Health News’ report. Neumann and advocacy groups supporting the legislation subsequently contacted health officials, advocating for doula services as a cost-effective way to deliver essential care.