S-4986-119
Read twice and referred to the Committee on Finance.
Sponsored by Elizabeth Warren (D-MA)
What it does
This bill would require all state Medicaid programs to cover services provided by doulas, midwives, tribal midwives, and lactation support providers during the prenatal, labor, and postpartum periods. It would prohibit states from charging Medicaid enrollees any cost-sharing (such as copayments) for these services. The bill defines qualifying credentials for each provider type and would take effect January 1, 2027, with a grace period for states that need to pass new legislation to comply.
Who benefits
Medicaid-enrolled pregnant and postpartum individuals, who represent roughly half of all U.S. births. Black, Indigenous, and other women of color who face disproportionately high maternal mortality rates and may benefit most from expanded culturally congruent care. Doulas, midwives, tribal midwives, and lactation support providers who would gain a new, federally mandated payment stream. Rural and low-income patients who currently lack access to these services due to cost. Tribal communities, which receive explicit recognition through the "tribal midwife" category. Infants who may benefit from improved breastfeeding initiation and lower rates of low birth weight, per the bill's cited NIH data.
Who is hurt
State Medicaid programs and taxpayers, who would bear increased program costs from the new mandatory benefit. Obstetricians and hospital systems that currently provide the majority of Medicaid-covered maternity care and may face increased competition for patients. Certified nurse-midwives and other licensed providers who already operate within Medicaid may face market pressure from newly eligible, less-credentialed providers. States with stricter licensing regimes for midwives and doulas may face tension between their existing standards and the bill's alternative credentialing pathways. Federal taxpayers, who share Medicaid costs with states through the federal matching formula.
Supporters argue
Supporters argue that the U.S. maternal mortality rate — the highest among comparable wealthy nations — is a preventable crisis, with CDC data showing Black women die at more than three times the rate of White women and American Indian/Alaska Native women at four times that rate. They contend that doula and midwifery care is evidence-based: NIH data cited in the bill shows doula-supported births are four times less likely to produce low-birth-weight babies and twice as likely to avoid complications, while midwifery-led care is associated with lower cesarean rates and cost savings. Mandating Medicaid coverage removes a financial barrier that currently limits these proven interventions to higher-income patients.
Opponents argue
Opponents argue that creating a new mandatory Medicaid benefit imposes unfunded or underfunded obligations on states, which already face Medicaid budget pressures, and that the bill's alternative credentialing pathways — including client recommendations and international standards — may allow providers with less rigorous training than state-licensed practitioners to bill Medicaid, raising patient safety concerns. They contend that the evidence base for doula care, while promising, relies on studies that may not account for selection effects, and that the bill bypasses state licensing authority by establishing federal credential floors that could conflict with stricter state standards, raising Spending Clause coercion questions similar to those identified in NFIB v. Sebelius (2012).