Montana Postpones Doula Medicaid Payments Amid Budget Shortfall
Montana has postponed the implementation of Medicaid reimbursement for doula services, citing a budget shortfall. This decision comes as states anticipate significant reductions in federal Medicaid funding.
This decision comes as states anticipate significant reductions in federal Medicaid funding.
Misty Pipe, a doula on the Northern Cheyenne Indian Reservation, provides free support to new and expectant parents due to the absence of local birthing facilities. Montana lawmakers had approved Medicaid payments of up to $1,600 per pregnancy for doulas, a service expected to address care gaps, particularly in remote areas.
Montana's Decision and Financial Strain
The state's Department of Public Health and Human Services (DPHHS) announced in late March that it would not proceed with adding doula services to its Medicaid program. DPHHS spokesperson Holly Matkin attributed this to higher-than-expected Medicaid costs and a projected $146.3 million shortfall in federal Medicaid funds for the current year.
An additional deficit is anticipated for the following year, partly due to the One Big Beautiful Bill Act, signed last year, which is expected to reduce federal Medicaid spending by nearly $1 trillion over 10 years.
National Trend: Medicaid Services at Risk
Optional Medicaid services, such as doula support, home health care, and dental work, are at risk nationwide as states prepare for federal cuts. Idaho is considering Medicaid reductions, and Missouri officials have proposed cutting services for people with disabilities. Montana's health department head, Charlie Brereton, indicated that further Medicaid cutbacks are possible.
Optional Medicaid services, such as doula support, home health care, and dental work, are at risk nationwide as states prepare for federal cuts.
Addressing Maternity Care Deserts
Stephanie Morton, executive director of Healthy Mothers, Healthy Babies-The Montana Coalition, stated that over half of Montana's counties are designated as maternity care deserts, and budget cuts will further diminish services.
Rural maternity care deserts are a national issue, with predominantly Native American communities facing the longest distances to obstetric facilities. Indigenous women experience higher rates of pregnancy complications and mortality.
Disparities for Indigenous Women
The federal Indian Health Service (IHS) is chronically underfunded, and few of its facilities offer labor and delivery services. Medicaid serves as a primary source of health coverage for many Native Americans.
Historical inequities, including forced sterilizations and child removals, have contributed to distrust of health systems among Native women. Emily Haozous of the Pacific Institute for Research and Evaluation's Southwest center noted that systemic barriers limit access to care for Native American women.
The "One Big Beautiful Bill Act" and Its Repercussions
The One Big Beautiful Bill Act will introduce more frequent eligibility checks and work requirements for Medicaid access, potentially causing 5.3 million people to lose coverage by 2034. While Native Americans are exempt from some new rules, they can face administrative hurdles in enrollment and proving tribal status. Montana aims to implement work requirements this summer, ahead of the federal deadline.
The One Big Beautiful Bill Act will introduce more frequent eligibility checks and work requirements for Medicaid access, potentially causing 5.3 million people to lose coverage by 2034.
Community Resilience
Misty Pipe plans to continue her doula work alongside her post office job, focusing on training more community members to provide grassroots support.