{"id":2229052,"date":"2026-04-22T05:00:00","date_gmt":"2026-04-22T09:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?p=2229052"},"modified":"2026-04-22T07:56:44","modified_gmt":"2026-04-22T11:56:44","slug":"doula-care-pregnancy-medicaid-montana-budget-cuts","status":"publish","type":"post","link":"https:\/\/kffhealthnews.org\/medicaid\/doula-care-pregnancy-medicaid-montana-budget-cuts\/","title":{"rendered":"Montana Moves Ahead With Doula Pay but Warns Medicaid Cuts Still May Come"},"content":{"rendered":"\n<div class=\"wp-block-kff-shared-article-hero\">\n\t\n<div class=\"wp-block-kff-shared-article-hero wp-block-kff-shared-article-hero--header-first wp-block-kff-shared-article-hero--background-white\">\n\t\t\t\t<h1 class=\"wp-block-kff-shared-article-hero__title\">Montana Moves Ahead With Doula Pay but Warns Medicaid Cuts Still May Come<\/h1>\n\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__byline-and-date\">\n\t\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__byline-section\">\n\t\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__author\">\n\t\tBy <a href=\"https:\/\/kffhealthnews.org\/author\/katheryn-houghton\/\">Katheryn Houghton<\/a>\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__date-container\">\n\t\t\t\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__date\">\n\t\tApril 22, 2026\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n\t<div class=\"wp-block-kff-shared-article-hero__buttons\">\n\t\t\t<div class=\"wp-block-kff-shared-article-hero__republish-button\">\n\t\t<button id=\"cc-btn\" type=\"button\" onclick=\"window.location.href='\/republish\/wp-json\/wp\/v2\/posts\/2229052'\" role=\"link\" class=\"wp-block-kff-shared-article-hero__republish-btn\">\n\t\t\t<span class=\"wp-block-kff-shared-article-hero__republish-btn-text\">Republish<\/span>\n\t\t<\/button>\n\t<\/div>\n\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__spanish-button\">\n\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/es\/spanish-homepage\/\" class=\"wp-block-kff-shared-article-hero__spanish-btn\">\n\t\t\t\t<span class=\"wp-block-kff-shared-article-hero__spanish-btn-text\">\n\t\t\t\t\tDisponible en Espa\u00f1ol\t\t\t\t<\/span>\n\t\t\t<\/a>\n\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/chinese\/\" class=\"wp-block-kff-shared-article-hero__spanish-btn\">\n\t\t\t\t<span class=\"wp-block-kff-shared-article-hero__spanish-btn-text\">\n\t\t\t\t\tAvailable in Chinese\t\t\t\t<\/span>\n\t\t\t<\/a>\n\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/korean\/\" class=\"wp-block-kff-shared-article-hero__spanish-btn\">\n\t\t\t\t<span class=\"wp-block-kff-shared-article-hero__spanish-btn-text\">\n\t\t\t\t\tAvailable in Korean\t\t\t\t<\/span>\n\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"wp-block-kff-shared-article-hero__image alignwide\">\n\t\t\t<img\n\t\t\t\tsrc=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/04\/MT-Doula_05.jpg\"\n\t\t\t\talt=\"A doula holds a baby while sitting on a couch.\"\n\t\t\t\tclass=\"wp-block-kff-shared-article-hero__featured-image\"\n\t\t\t\/>\n\t\t\t\t\t\t\t<div class=\"wp-block-kff-shared-article-hero__image-caption\">\n\t\t\t\t\tMisty Pipe, a doula in Lame Deer, Montana, on the Northern Cheyenne Indian Reservation, visits with a family she had recently supported through pregnancy. Lame Deer is about 100 miles from the closest hospital that delivers babies, so Pipe offers free doula care outside of her post office job. \u201cWomen need this help,\u201d Pipe says.\t\t\t\t\t\t\t\t\t\t\t<span class=\"wp-block-kff-shared-article-hero__image-credit\"> (Katheryn Houghton\/KFF Health News)<\/span>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t<\/div>\n\t<\/div>\n\n\n<div class=\"wp-block-kff-news-modern-news-content-container\">\n\t\n\n<p>Montana officials said they are moving forward with plans to allow Medicaid to pay doulas, reversing a previous statement that budget problems had prompted them to pause the effort to reimburse the birth workers.<\/p>\n\n\n\n<p>But officials warned that all optional Medicaid services are still under review as the state health department looks for cuts to offset a shortfall driven by higher-than-expected Medicaid costs.<\/p>\n\n\n\n<aside class=\"wp-block-kff-shared-sidebar alignright \">\n\t\n\n<p class=\"has-text-align-left has-source-sans-3-font-family has-heading-5-font-size\"><strong>Use Our Content\u00a0<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-left has-source-sans-3-font-family\">\u00a0It can be <a href=\"https:\/\/kffhealthnews.org\/news\/article\/medicaid-cuts-work-requirements-state-staff-shortages\/view\/republish\/\">republished for free<\/a>.\u00a0<\/p>\n\n\n<div class=\"wp-block-kff-shared-promo-container alignright  wp-block-kff-shared-promo-container--top-border\">\n\t\t\t<div class=\"wp-block-kff-shared-promo-container__eyebrow\">\n\t\t\tRelated Coverage\t\t<\/div>\n\t\t\n\n\n<article class=\"wp-block-kff-shared-post-card--top wp-block-kff-shared-post-card--aligned  wp-block-kff-shared-post-card---variation-lede-news wp-block-kff-shared-post-card\" id=\"post-2176418\" data-image-size=\"3:2\">\n\n\t\t\t<div class=\"wp-block-kff-shared-post-card__thumbnail-wrapper\">\n\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/health-care-costs\/doula-care-indigenous-health-medicaid-cuts-montana-tribe\/\" class=\"wp-block-kff-shared-post-card__thumbnail jetpack-lazy-image wp-block-kff-shared-post-card__thumbnail--ratio-3:2 \">\n\t\t\t<picture>\n\t\t\t\t<source srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/03\/MT-Doula_01.jpg?w=300&amp;h=200&amp;crop=1 1x, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/03\/MT-Doula_01.jpg?w=600&amp;h=400&amp;crop=1 2x\" media=\"(max-width: 500px)\"><source srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/03\/MT-Doula_01.jpg?w=834&amp;h=556&amp;crop=1 1x, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/03\/MT-Doula_01.jpg?w=1668&amp;h=1112&amp;crop=1 2x\" media=\"(min-width: 500px)\">\t\t\t\t<img width=\"300\" height=\"200\" alt=\"A doula stands next to a young mother sitting in a chair draped with colorful fabric. She holds a young baby in her arms.\">\t\t\t<\/picture>\n\t\t<\/a>\n\t\t\t\t<\/div>\n\t\n\t<div class=\"wp-block-kff-shared-post-card__main\">\n\n\t\t\n\t\t\t\t\t<h1 class=\"wp-block-kff-shared-post-card__heading light\"><a href=\"https:\/\/kffhealthnews.org\/health-care-costs\/doula-care-indigenous-health-medicaid-cuts-montana-tribe\/\">This Northern Cheyenne Doula Was About To Start Getting Paid \u2014 Then Medicaid Cuts Hit<\/a><\/h1>\t\t\n\t\t\n\t\t\n\t\t\n\t\t\t\t\t<div class=\"wp-block-kff-shared-post-card__author-name-date\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-kff-shared-post-card__author-byline\">By <a href=\"https:\/\/kffhealthnews.org\/author\/katheryn-houghton\/\">Katheryn Houghton<\/a><\/div>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"wp-block-kff-shared-post-card__date\">April 7, 2026<\/div>\t\t\t\t\t\t\t<\/div>\n\t\t\n\t\t\t\t\n\t\t\t<\/div>\n<\/article>\n\n\n<\/div>\n\n\n<\/aside>\n\n\n<p>Jon Ebelt, a spokesperson with the Montana Department of Public Health and Human Services, said the agency is preparing a request to the federal government to add doula care to the state\u2019s Medicaid program. It would cost the state about $118,000 in its first year to provide doula Medicaid reimbursements, according to <a href=\"https:\/\/docs.legmt.gov\/download-ticket?ticketId=df27b1ce-f28d-4738-8761-ba49d9b320f9\">state estimates<\/a>.<\/p>\n\n\n\n<p>His April 15 comments came three weeks after department officials <a href=\"https:\/\/kffhealthnews.org\/news\/article\/doula-care-indigenous-health-medicaid-cuts-montana-tribe\/\">told KFF Health News<\/a> that the state budget deficit had put those plans on hold. Ebelt denied that a final decision had been made in March to scrap the doula Medicaid payments, which state lawmakers approved in a bill last year. The coverage is \u201cnow proceeding as planned,\u201d he said.<\/p>\n\n\n\n<p>\u201cAt the time of your initial inquiry, we were still in the process of analyzing the appropriation,\u201d Ebelt said.<\/p>\n\n\n\n<p>Federal health officials must approve any amendments to the state\u2019s Medicaid program before payments can begin. <a href=\"https:\/\/healthlaw.org\/doulamedicaidproject\/\">At least 25 other states<\/a> reimburse doulas through Medicaid.<\/p>\n\n\n\n<p>Doulas are trained, nonmedical workers who support people through pregnancy and after they give birth. The care they provide is <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC10292163\/\">linked to reductions<\/a> in health complications, which has prompted <a href=\"https:\/\/kffhealthnews.org\/news\/article\/doula-medicaid-state-laws-bipartisan-project-2025-south-carolina-montana\/\">more states to cover<\/a> doula services in recent years.<\/p>\n\n\n\n<p>Montana lawmakers who supported expanding Medicaid to cover doula care in 2025 cited scarce maternity services, especially in rural and Indigenous communities. But this year, the state has a Medicaid budget deficit of more than <a href=\"https:\/\/archive.legmt.gov\/content\/Publications\/fiscal\/2027-Biennium\/Committees\/Section-B\/DPHHS-Department-Updates-March2026.pdf\">$177 million<\/a> and is expecting a similar shortfall next year. Plus, federal policy changes slated to take effect later this year are expected to increase costs.<\/p>\n\n\n\n<p>\u201c\u200aThere\u2019s a need and a desire for doula services, but a lot of people can\u2019t afford it,\u201d said Sheri Walker, a Helena-based doula and president of the <a href=\"https:\/\/www.instagram.com\/montanadoulacollaborative\/\">Montana Doula Collaborative<\/a>. \u201cSo that means many of us have other jobs that we have to juggle.\u201d<\/p>\n\n\n\n<p>Walker is a part-time labor and delivery nurse outside of her doula work.<\/p>\n\n\n\n<p>On March 25, health department spokesperson Holly Matkin said in an email to KFF Health News that the agency \u201cwill not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.\u201d She had added that it was unclear whether state law gives the department the authority to authorize coverage during the budget shortfall.<\/p>\n\n\n\n<p>State Sen. <a href=\"https:\/\/legislators.legmt.gov\/#\/legislator\/229\">Cora Neumann<\/a>, a Democrat who sponsored last year\u2019s bipartisan doula reimbursement bill, said she didn\u2019t know about the department\u2019s plans until she saw KFF Health News&#8217; reporting. Neumann said she and groups that had backed the legislation began calling health officials, making the case for doula services as a low-cost way to provide critical care.<\/p>\n\n\n\n<p>After about a week, Neumann said, state officials told her the agency was moving ahead with doula services after all.<\/p>\n\n\n\n<p>\u201cThey were on the chopping block,\u201d Neumann said. \u201cThis is a story of how important it is for all Montanans to pay attention and stay connected to what\u2019s happening.\u201d<\/p>\n\n\n<div\n\tclass=\"wp-block wp-block-kff-shared-newsletter  wp-block-kff-shared-newsletter--background-white\"\n\tdata-type=\"kff-shared\/newsletter\"\n\tdata-align=\"center\"\n>\n\t<div class=\"wp-block-kff-shared-newsletter__container\">\n\t\t<div class=\"wp-block-kff-shared-newsletter__content\">\n\t\t\t<img \n\t\t\t\tsrc=\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\" \n\t\t\t\talt=\"Newsletter Icon\"\n\t\t\t\tclass=\"wp-block-kff-shared-newsletter__img\"\n\t\t\t\/>\n\t\t\t<div class=\"wp-block-kff-shared-newsletter__text\">\n\t\t\t\t<h4 class=\"newsletter__title\">\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n\t\t\t\t<p class=\"newsletter__description\">\n\t\t\t\t\tSubscribe to KFF Health News&#039; free weekly newsletter, &quot;The Week in Brief.&quot;\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"wp-block-kff-shared-newsletter__form\">\n\t\t\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"4d629ac695\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/posts\/2229052\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n\n<p>Ebelt did not clarify what led the department to change its position. However, he warned that optional Medicaid services, such as doula services, may still be cut.<\/p>\n\n\n\n<p>\u201cAll optional services, including this service, are being reviewed,\u201d Ebelt said, referring to doula care. He did not respond to a follow-up query as to whether the department might still decide to postpone the program following federal approval.<\/p>\n\n\n\n<p><a href=\"https:\/\/www.medicaid.gov\/medicaid\/benefits\/mandatory-optional-medicaid-benefits\">Optional services<\/a> are types of care that states choose to cover through their Medicaid programs but aren\u2019t required by federal law. That can include covering eyeglasses, prescription drugs, and prosthetics, and more specialized care such as physical therapy, or inpatient psychiatric services for people under 21.<\/p>\n\n\n\n<p>Those services may not sound optional, said <a href=\"https:\/\/www.kff.org\/person\/elizabeth-williams\/\">Liz Williams<\/a>, who studies Medicaid financing at KFF, a health information nonprofit that includes KFF Health News. But she said they\u2019re one of the few avenues states have to make adjustments when budgets get tight.<\/p>\n\n\n\n<p><a href=\"https:\/\/www.kff.org\/person\/elizabeth-williams\/\"><\/a>Congressional Republicans\u2019 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 <a href=\"https:\/\/kffhealthnews.org\/news\/article\/snap-food-stamps-hunger-work-requirements-one-big-beautiful-bill\/\">costs to provide food assistance<\/a>.<\/p>\n\n\n\n<p>Williams said many states expanded services in recent years by boosting optional Medicaid benefits and provider pay.<\/p>\n\n\n\n<p>\u201cWe could see them walk those back,\u201d Williams said.<\/p>\n\n\n\n<p>Montana\u2019s financial problems preceded federal changes. Last year, state lawmakers cut some of the health department\u2019s funding and underestimated Medicaid use. The state also overestimated what the federal government would pay toward Montana\u2019s Medicaid costs.<\/p>\n\n\n\n<p>Health officials must outline a plan to cut costs before the state\u2019s 2027 budget year begins on July 1. Simultaneously, the agency is trying to hire more staffers to begin vetting whether Medicaid enrollees meet or are exempt from new work requirements that also go in place July 1. The new rules, mandated through long-delayed state legislation and the federal spending law, will have a three-month grace period.<\/p>\n\n\n\n<p>Stephanie Morton, executive director of <a href=\"https:\/\/hmhb-mt.org\/\">Healthy Mothers, Healthy Babies-The Montana Coalition<\/a>, said she\u2019s grateful the state is back on track to pay for doula services through Medicaid. But she said she\u2019s worried about potential health care cuts to come.<\/p>\n\n\n\n<p>\u201cWe know that doulas are a critical piece of that infrastructure, but standing alone and losing other sources of care really isn\u2019t optimal,\u201d Morton said. \u201cThese are not robust systems as it stands.\u201d<\/p>\n\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Montana health officials say they\u2019re seeking to add doula services to the state\u2019s Medicaid program, reversing a previous statement that they would \u201cnot be moving forward\u201d amid a budget shortfall.<\/p>\n","protected":false},"author":155412762,"featured_media":2229411,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"ep_exclude_from_search":false,"_classifai_error":"","_classifai_text_to_speech_error":"","hide_from_search":false,"apple_news_api_created_at":"","apple_news_api_id":"","apple_news_api_modified_at":"","apple_news_api_revision":"","apple_news_api_share_url":"","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":[],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"show_featured_image":false,"republication-tracker-tool-hide-widget":false,"subheading":"","tag":"","kff-is-frameless":false,"story_update":"","update_position":"","language":"","translation_parent":0,"translation_child":[],"search_keywords":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"shortlink":"","pre_footer_title":"","pre_footer_description":"","pre_footer_links":[],"_use_transparent_header":false,"_header_mode":"light","kaiser_health_news_kicker":"","kaiser_health_news_kicker_url":"","kaiser_health_news_update_time":"","photo_byline":[],"funders_suppress":false,"funders_override_text":false,"funders_override_text_content":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[439524256,178379,12498,140023],"tags":[439525648,439529136,439529577,439529113,439524171,35359259],"podcast-series":[],"state":[3837],"content-types":[],"series":[439530184],"funder":[439528770,439527044,439528999,439527043],"community-media":[],"partner":[],"coauthors":[439527331],"class_list":["post-2229052","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care-costs","category-health-industry","category-insurance","category-medicaid","tag-mountain-states-bureau","tag-pregnancy","tag-reproductive-health","tag-rural-health","tag-trump-administration","tag-womens-health","state-montana","series-state-watch","funder-arnold-ventures","funder-headwaters-foundation","funder-helmsley-charitable-trust","funder-montana-healthcare-foundation"],"pp_statuses_selecting_workflow":false,"pp_workflow_action":"current","pp_status_selection":"publish","pp_force_visibility":null,"pp_subpost_visibility":null,"pp_inherited_force_visibility":null,"pp_inherited_subpost_visibility":null,"pp_post_mime_type":"","apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.3) - 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