Maternal Health and Rural Care

Montana’s Department of Public Health and Human Services has postponed the launch of a new Medicaid benefit that would have reimbursed doulas up to $1,600 per pregnancy, citing a projected $146.3 million shortfall in federal Medicaid funds for this year. The state had finalized licensing rules in January and was set to join at least 25 other states paying doulas under Medicaid, a move aimed at reducing costly birth and postpartum complications in rural and tribal communities like the Northern Cheyenne Reservation, where the nearest maternity hospital is about 100 miles away. Officials say higher-than-expected Medicaid costs and anticipated reductions from the Republicans’ One Big Beautiful Bill Act—which is expected to cut nearly $1 trillion from federal Medicaid spending over a decade—are driving the squeeze, and they warn another deficit is likely next year. For local doulas such as Lame Deer resident Misty Pipe, who currently supports pregnant women for free around her day job at the post office, the delay means the work remains financially unsustainable and many low-income Native families will continue to go without support that studies link to better maternal and infant outcomes. The decision is an early, concrete example of how states are starting to pare back or freeze Medicaid services in anticipation of coming federal cuts, a trend that health-policy watchers online are warning could widen disparities in maternal and rural health care across the country.