Montana passed a law in May 2025 that makes doula work a licensed occupation. From January 1, 2027, a person may not practice as a doula in the state without a license from the Department of Labor and Industry, and Montana Medicaid is being amended to pay licensed doulas.1 This article covers what the law requires, what it costs, what a licensed doula can be disciplined for, and how to find out whether your own state is doing the same thing.
Key takeaways
- Senate Bill 319 was signed May 12, 2025. Licenses became available January 1, 2026 and become mandatory January 1, 2027.1
- Exempt: tribal traditional healing providers and anyone supporting a friend or family member.1
- Under the department's proposed rules: $180 to apply, $175 a year to renew, current CPR, and either 20 hours of approved training or 40 supervised hours.5
- Montana Medicaid filed a state plan amendment with a July 1, 2026 effective date. Only licensed doulas can bill.7
- A licensed doula can be disciplined for "conduct that does not meet generally accepted standards of practice" and for "failing to refer a client for clinical care when necessary."4,5
- In 26 other states and D.C., Medicaid pays doulas, but certification is tied to billing, not to the right to work. Montana is the first state in the public record to require a license to practice at all.9,10
- The act expires December 31, 2030 unless the legislature renews it.1
This article is for education only. It is not legal advice, medical advice, or a substitute for either. I am a clinical herbalist, not a lawyer or a physician. Laws and agency rules change, and the rules described here were still being finalized when this was written. If you are a doula or a parent making decisions based on this law, read the statute and the current Department of Labor and Industry rules yourself, or ask a licensed attorney. If you are in a medical emergency, call 911.
Is this only Montana, or does it affect other states?
Source basis: NASHP state tracker (HRSA-funded), National Health Law Program survey, state bill summaries and state plan amendments.
Two separate things are happening across the country.
The first is Medicaid payment. As of March 2026, 26 states and Washington, D.C. reimburse doulas through Medicaid, and seven more (Arkansas, Maine, Montana, Nebraska, New Hampshire, Tennessee, Vermont) were setting programs up.9,11 In those states, a doula who wants to be paid by Medicaid has to meet whatever qualification the state sets. In most states that is a training certificate from an approved organization. In a few (Arizona, New Hampshire, Massachusetts, Ohio, Arkansas) it is a state-issued certification.10,12,13
The second is the right to work at all. In every state except Montana, a doula who does not take Medicaid money can keep working without any state credential. Arizona's 2021 law says so in its own fact sheet: certification is voluntary and "a doula is not required to be certified" to practice.12 The National Health Law Program, which tracks these programs, wrote in 2024 that no state had mandatory licensure for doulas.10
Montana is different. SB 319 was introduced as a voluntary certification bill and was amended during the session. As passed, it says that beginning January 1, 2027, "a person may not practice as a doula unless licensed."1,2
If you live outside Montana, there are two things to check: whether your state pays for doula care through Medicaid, and whether a doula licensing bill has been filed in your legislature. The NASHP tracker answers the first. Your state legislature's bill search answers the second. Search "doula" and "license" together.
What SB 319 says
Source basis: enrolled bill text, Chapter 597, Laws of Montana 2025.
The law defines a doula as "a trained, nonmedical professional who provides continuous physical, emotional, and informational support to a pregnant woman during the antepartum, intrapartum, or postpartum period." Postpartum means the 12 months after the pregnancy ends.1
Two groups are excluded from the definition: a "traditional healing provider" recognized by an American Indian or Alaska Native tribe, and "a person providing services to a friend or family member."1 A relative or friend who supports you through labor does not need a license.
A third group is exempt under a separate section. Peer mentors, advocates, coaches, and members of volunteer organizations may keep doing work "consistent with the person's training, as long as the person does not represent by title that the person is engaging in the practice of doula care."3 The license is required to use the title "doula" and to work in that role for pay.
The licensing agency is the Department of Labor and Industry, not the health department. Doulas are placed under Title 37, chapter 1, part 4 of the Montana Code, the section for licensed occupations that have no board of their own.1,2 The department writes the rules, investigates complaints, and decides discipline.
Doulas who were practicing before January 1, 2026 have until December 31, 2027 to show the department that their experience is equivalent to the licensing requirements.1
What a license requires
Source basis: statute, and the Department of Labor and Industry's proposed rules (MAR Notice 2025-191.1, October 2025). Fees and hours below are from the proposal; confirm against the adopted rules at ARM Title 24, chapter 139.
The statute sets four conditions: a completed application, fees, competencies the department defines by rule, and no history of unprofessional conduct or open disciplinary case.2 The department's proposed rules fill in the detail.5
New doulas
- Application fee of $180, renewal of $175 every year.
- Current CPR certification.
- Either 40 hours of supervised training with a licensed doula that includes at least two births or perinatal visits, or 20 hours of training from a department-approved provider across topics such as labor and birth education, lactation, advocacy and communication, ethics, perinatal mental health, grief and loss, trauma-informed care, and cultural safety.
Doulas already in practice
- A doula who practiced for at least two years before January 1, 2026 submits an application and a list of five to ten clients served in that period, identified by initials and date range. No added training or supervision is required.
Out-of-state doulas
- A doula licensed in a state the department deems substantially equivalent can be licensed by endorsement. The department publishes that list on its website.
The department estimated 100 to 200 applicants in the first year, which puts the total cost to Montana doulas at $20,000 to $40,000 in year one.5 The program page says licenses are available now and will be required from January 1, 2027.6
What Medicaid will pay for
Source basis: statute, DPHHS state plan amendment public notice (June 30, 2026), and reporting by Montana Free Press and KFF Health News.
SB 319 added "services of doulas licensed under" the new chapter to the list of optional services Montana Medicaid may cover.1 Optional means the department can add or remove it by rule, and the legislature can stop funding it.
The benefit was paused once already. On March 25, 2026, a DPHHS spokesperson told KFF Health News the department "will not be moving forward" with doula coverage because of a Medicaid budget shortfall.14 Four weeks later a different spokesperson said coverage was "now proceeding as planned" and that the department was preparing its request to the federal government.15 On June 30, 2026, DPHHS posted the state plan amendment for public comment. It adds licensed doula services under Preventive Services, covers "non-clinical physical, emotional, and informational support" during the perinatal period, and carries a proposed effective date of July 1, 2026. The fiscal impact for the state's 2027 fiscal year is $456,000, the amount the 2025 legislature appropriated.7
Two other numbers appear in the record. The governor's budget office estimated the program at about $119,000 a year, assuming doulas attend 6 percent of Medicaid births.8 KFF Health News reported that lawmakers authorized up to $1,600 per pregnancy.14 That per-pregnancy figure is not in the bill text, so treat it as reported rather than confirmed.
About 40 percent of Montana births are paid for by Medicaid.16 For those families, the cost barrier to a doula goes away, provided the doula is licensed and enrolled as a Medicaid provider. For everyone else, who pays does not change.
What a licensed doula can be disciplined for
Source basis: 37-1-410 MCA and the department's proposed unprofessional conduct rule.
Before 2027, a doula answered to her clients. After 2027, she also answers to the Department of Labor and Industry, and anyone can file a complaint.6
Every licensed occupation under Title 37, chapter 1, part 4 is subject to the same list of unprofessional conduct, and SB 319 added doulas to that part.1,4 Most items on the list are specific: fraud, practicing while impaired, revealing confidential information. Two items are broad. One is "violating a federal, state, or local law or rule relating to the conduct of the profession." The other is "conduct that does not meet generally accepted standards of practice."4 The statute does not say who decides what the generally accepted standard for a doula is.
The department's proposed doula rule adds seven more grounds, including "failing to support communication between the client and the client's health care team," "failing to refer a client for clinical care when necessary," and "failing to maintain records of services provided."5 The rule does not define "when necessary." Supervision records for limited-license doulas must be kept for seven years.5
One line runs the other way. Subsection (2) of 37-1-410 says it is not unprofessional conduct for a licensee "to engage in the exercise of rights protected under the free exercise clause or the free speech clause" of the Montana or United States constitution.4 Whether that protects a doula who speaks up for a client in a hospital room has not been tested.
Disciplinary actions are posted to the department's public license lookup.6
Questions to ask a doula before you hire one
Source basis: the requirements and exemptions described above.
These apply in Montana now and in any state that adopts a similar law.
- Are you licensed with the Department of Labor and Industry, or applying under the experience pathway before the December 31, 2027 deadline?
- Are you enrolled as a Montana Medicaid provider, and does your contract change if Medicaid is paying?
- What does "necessary" mean to you when it comes to referring a client for clinical care, and what would you do if you and I disagreed with a provider in the room?
- What records do you keep about my pregnancy and birth, who can see them, and how long do you keep them?
- If I want someone who is not a licensed doula at my birth (a sister, a friend, a traditional healer, a childbirth educator), how do you work alongside them?
The third question matters most, because a doula is often the only person in the room whose job is to help you ask questions and decline things you do not want. We wrote about that role in The Need for Informed Consent.
The law expires in 2030
Source basis: Section 10 of SB 319.
SB 319 terminates on December 31, 2030.1 The sponsor described the sunset in committee as the point where doulas can come back in four years "if it's in fact not working for their profession."16 By then the department will have a complaint record, a count of licensed doulas, and Medicaid claims data. Whether the law is renewed, changed, or dropped will depend on what those records show and on who testifies.
Frequently asked questions
Do doulas need a license in Montana?
Not until January 1, 2027. After that date, yes, unless you are a tribal traditional healing provider or you are supporting a friend or family member.1,2
Does Montana Medicaid cover doulas?
The state filed the amendment to add licensed doula services with a proposed effective date of July 1, 2026. Coverage depends on federal approval and on the state keeping the optional benefit funded. Ask your Medicaid plan directly.7
Can a family member or friend act as my doula?
Yes. The law's definition of doula excludes "a person providing services to a friend or family member."1
Which states cover doula care through Medicaid?
As of March 2026, 26 states and Washington, D.C., with seven more in progress. The NASHP tracker lists them with each state's visit limits and rates.9
Is Montana the only state that licenses doulas?
Several states offer voluntary certification, usually as a condition of Medicaid billing. Montana is the only state in the public record that makes a license a condition of working as a doula at all.10,12
How do I file a complaint against a licensed doula in Montana?
Through the Department of Labor and Industry's complaint page. Disciplinary actions are posted to the public license lookup.6
Sources
- Montana Legislature. Senate Bill 319, enrolled bill, Chapter 597, Laws of Montana 2025. archive.legmt.gov
- Montana Code Annotated 37-77-102, License requirements (effective January 1, 2026). archive.legmt.gov
- Montana Code Annotated 37-77-103, Exemptions. archive.legmt.gov
- Montana Code Annotated 37-1-410, Unprofessional conduct. mca.legmt.gov
- Montana Department of Labor and Industry. Notice of Proposed Rulemaking, MAR Notice No. 2025-191.1, Montana Administrative Register Issue No. 19, October 10, 2025. dli.mt.gov
- Montana Department of Labor and Industry. Doula Program page and program rules (ARM Title 24, chapter 139). boards.bsd.dli.mt.gov
- Montana Department of Public Health and Human Services. Multiple State Plan Amendments Posted Online for Public Comment, June 30, 2026 (Preventive Services SPA, Licensed Doula Services). dphhs.mt.gov
- Mabie, Nora. "Bill could increase access to doula care in Montana." Montana Free Press, March 25, 2025. Independent nonprofit newsroom. montanafreepress.org
- National Academy for State Health Policy. State Medicaid Approaches to Doula Service Benefits, updated March 31, 2026. Funded by the federal Health Resources and Services Administration (grant U1XMC54191). nashp.org
- National Health Law Program. "Doula Medicaid Training and Certification Requirements: Summary of Current State Approaches." Nonprofit legal advocacy organization; foundation funded. healthlaw.org
- Feminist Majority Foundation. "More Than Half of States Now Cover Doula Care Under Medicaid," April 2026. Advocacy organization. feminist.org
- Arizona State Senate. Fact Sheet for S.B. 1181, doulas; voluntary certification (2021). azleg.gov
- Centers for Medicare and Medicaid Services. New Hampshire State Plan Amendment 25-0015, approved July 8, 2026. medicaid.gov
- Houghton, Katheryn. "This Northern Cheyenne Doula Was About To Start Getting Paid, Then Medicaid Cuts Hit." KFF Health News, April 2026. Nonprofit newsroom funded by the KFF foundation. kffhealthnews.org
- Houghton, Katheryn. "Montana moves ahead with doula pay but warns Medicaid cuts still may come." Montana Free Press via KFF Health News, April 22, 2026. montanafreepress.org
- Mabie, Nora. "Governor signs new law professionalizing doula care." Montana Free Press, May 14, 2025. montanafreepress.org
