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Montana Moves Ahead With Doula Pay but Warns Medicaid Cuts Still May Come

Katheryn Houghton — Wed, 22 Apr 2026 09:00:00 +0000

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.

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.

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’s Medicaid program. It would cost the state about $118,000 in its first year to provide doula Medicaid reimbursements, according to .

His April 15 comments came three weeks after department officials told ��ϳԹ�� News 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 “now proceeding as planned,” he said.

“At the time of your initial inquiry, we were still in the process of analyzing the appropriation,” Ebelt said.

Federal health officials must approve any amendments to the state’s Medicaid program before payments can begin. reimburse doulas through Medicaid.

Doulas are trained, nonmedical workers who support people through pregnancy and after they give birth. The care they provide is in health complications, which has prompted more states to cover doula services in recent years.

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 and is expecting a similar shortfall next year. Plus, federal policy changes slated to take effect later this year are expected to increase costs.

“ There’s a need and a desire for doula services, but a lot of people can’t afford it,” said Sheri Walker, a Helena-based doula and president of the . “So that means many of us have other jobs that we have to juggle.”

Walker is a part-time labor and delivery nurse outside of her doula work.

On March 25, health department spokesperson Holly Matkin said in an email to ��ϳԹ�� News that the agency “will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time.” She had added that it was unclear whether state law gives the department the authority to authorize coverage during the budget shortfall.

State Sen. , a Democrat who sponsored last year’s bipartisan doula reimbursement bill, said she didn’t know about the department’s plans until she saw ��ϳԹ�� News’ 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.

After about a week, Neumann said, state officials told her the agency was moving ahead with doula services after all.

“They were on the chopping block,” Neumann said. “This is a story of how important it is for all Montanans to pay attention and stay connected to what’s happening.”

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.

“All optional services, including this service, are being reviewed,” 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.

are types of care that states choose to cover through their Medicaid programs but aren’t 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.

Those services may not sound optional, said , who studies Medicaid financing at KFF, a health information nonprofit that includes ��ϳԹ�� News. But she said they’re one of the few avenues states have to make adjustments when budgets get tight.

Congressional Republicans’ 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 costs to provide food assistance.

Williams said many states expanded services in recent years by boosting optional Medicaid benefits and provider pay.

“We could see them walk those back,” Williams said.

Montana’s financial problems preceded federal changes. Last year, state lawmakers cut some of the health department’s funding and underestimated Medicaid use. The state also overestimated what the federal government would pay toward Montana’s Medicaid costs.

Health officials must outline a plan to cut costs before the state’s 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.

Stephanie Morton, executive director of , said she’s grateful the state is back on track to pay for doula services through Medicaid. But she said she’s worried about potential health care cuts to come.

“We know that doulas are a critical piece of that infrastructure, but standing alone and losing other sources of care really isn’t optimal,” Morton said. “These are not robust systems as it stands.”

��ϳԹ�� News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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As US Birth Rate Falls, Feds’ Response May Make Pregnancy More Dangerous

Céline Gounder — Thu, 16 Apr 2026 09:00:00 +0000

The number of babies born in the United States fell again last year.

This story also ran on . It can be republished for free.

According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.

The Trump administration has said it wants to reverse this trend. President Donald Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also the federal government’s only dedicated family planning program: Title X.

For more than five decades, Title X has been geared — with bipartisan support — toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the served more than 5 million patients a year. Title X clients have reported the program as their sole source of health care in a given year.

In early April, the Department of Health and Human Services for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception — describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”

The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.

While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies — a long-standing goal of the program.

Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.

“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that Trump eliminating Title X altogether.

Birth Rates and Fertility Trends

The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.

The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,” she said.

Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.

“Having children has become more contingent and more planned,” she said.

Much of the decline since 2007 reflects women postponing births rather than forgoing them.

“The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45,” said Philip Cohen, a professor of sociology at the University of Maryland.

Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. “Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,” he said.

Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: “Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.”

Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda that seeks to boost birth rates by steering policy toward family formation.

The document’s language reflects both: It repeatedly invokes “optimal health” and “chronic disease” while sidelining the contraceptive services that have defined Title X for .

Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program “is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,” she said.

Title X’s New Focus

The administration’s changes have been welcomed on the right.

Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls “restorative reproductive medicine,” said the new funding notice reflects overdue attention to neglected aspects of women’s health.

“I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,” Waters said.

She described the notice as an expansion, not a narrowing, of the program’s mission: “I see this iteration of Title X as the fulfillment of its purpose. The goal was never just ‘more contraception’ but a wholesale empowerment of women to govern their own fertility.”

Waters also argued that untreated reproductive health problems may contribute to lower birth rates.

“One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids,” she said, pointing to endometriosis.

An estimated of reproductive age have endometriosis, and of those, . Scientifically speaking, the relationship is an association, not a proven cause. Women aren’t screened for endometriosis if they don’t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.

Infertility rates in the U.S., meanwhile, have not risen. An found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply — a divergence that points away from untreated reproductive disease as an explanation.

Meanwhile, in February, the American College of Obstetricians and Gynecologists enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.

Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are . When President Richard Nixon signed Title X into law in 1970, as a way to expand access to family planning services — helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. , not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it .

Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.

“There’s not even enough funding to support the core premise of contraception,” Romer said. “And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation.”

The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by KFF in 2024 reported having in the previous 12 months.

Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, “If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients.” Funding could move away from providers who offer a full range of contraceptive care, she added, “toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services.”

The Stakes Are High

The United States already has one of the highest maternal mortality rates among wealthy nations — as of 2024. According to the CDC, in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.

And since the Supreme Court’s Dobbs decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated , disproportionately among young women and women of color.

Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said “there is absolutely no evidence for any positive outcome of restricting access to contraception.” Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.

Since Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than . The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.

The second Trump administration’s overhaul of the program, Marcella said, “directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy.”

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This Northern Cheyenne Doula Was About To Start Getting Paid — Then Medicaid Cuts Hit

Katheryn Houghton — Tue, 07 Apr 2026 09:00:00 +0000

LAME DEER, Mont. — Misty Pipe had about an hour before her shift began at the post office. She used that time to check in on a new mom who lives a few miles outside this town at the heart of the Northern Cheyenne Indian Reservation.

A mom of seven, Pipe is a doula on the reservation who supports new and expectant parents. She does that work free, around her day job. That’s because in this town of about 2,000 people, the closest hospital that delivers babies is 100 miles away.

“Women need this help,” Pipe said.

Doulas ready parents for childbirth, support their deliveries, and can be a steady presence in a baby’s first months. their work with lower rates of costly birth and postpartum complications — especially in hard-to-reach places like Lame Deer.

But that help can be scarce. As Pipe put it: “Doula doesn’t pay the bills around here.”

Things were supposed to change this year. Montana was set to join that reimburse doulas through their Medicaid programs to ease gaps in care. Montana lawmakers approved the payments last year, authorizing up to $1,600 per pregnancy. Pipe hoped that money would give her the chance to leave her post office job one day to help more parents.

But the state Department of Public Health and Human Services postponed adding doula services to its Medicaid program in late March, citing a budget shortfall driven in part by higher-than-expected Medicaid costs.

“DPHHS will not be moving forward with the implementation of doula services in the Montana Medicaid benefit package at this time,” department spokesperson Holly Matkin told ��ϳԹ�� News.

The news caught Pipe by surprise — she hadn’t heard any updates in a while, but the state had finalized its licensing rules for doulas in January. Last year, she supported three people through their deliveries. She doesn’t have time for much more. That weighs on her. the people on the Northern Cheyenne Indian Reservation , and the people she helps usually can’t afford to pay a doula.

“I was looking forward to serving more people,” Pipe said. “Now that’s not going to happen anytime soon.”

Doula Misty Pipe holds Grover WolfVoice at her first check-in visit since his birth. Pipe says she’s most concerned about clients’ health after they return home, when postpartum complications can arise. (Katheryn Houghton/��ϳԹ�� News)

Grover, a few weeks old, is held by his father, Torey WolfVoice. Grover’s mom, Britney WolfVoice, says the doula care Pipe provided through the birth of her two youngest children made her feel safe and heard in hospitals for the first time in her life. (Katheryn Houghton/��ϳԹ�� News)

Charlie Brereton, who heads the health department, told state lawmakers in March that the agency projected a $146.3 million shortfall in federal Medicaid funds for this year. Health officials predict another deficit next year as states feel the effects of Republicans’ massive tax-and-spending law, the One Big Beautiful Bill Act. Signed last year, that law is projected to reduce federal Medicaid spending by nearly $1 trillion over 10 years.

Matkin said it’s “unclear” whether the agency can authorize doula coverage this year. The deficit will lead the department to seek supplemental funding from state lawmakers. When an agency makes that kind of request for the first year of the state’s two-year budget cycle, requires it to create a plan to reduce its spending.

Around the country, optional Medicaid services — such as doula support, home health care, and dental work — are at risk of losing funding as states brace for federal Medicaid cuts to hit their bottom lines. Already, lawmakers in Idaho are considering their own reductions to Medicaid to balance the state’s budget. cutting tens of millions of dollars in services for people with disabilities.

In Montana, doula services are unlikely to be the only Medicaid cutbacks announced. “All options are on the table,” Brereton told lawmakers in March.

Stephanie Morton, executive director of Healthy Mothers, Healthy Babies-The Montana Coalition, said more than half of Montana’s counties are designated as maternity care deserts.

“Budget cuts will continue to diminish the limited services families rely upon in these counties,” said Morton, whose nonprofit had advocated for doula Medicaid reimbursement. “This decision feels like the first of many rollbacks and cuts Montanans will face.”

Laboring Alone

At the check-in just outside town, Pipe handed a waking newborn to his mother and unwrapped a new swaddle for the child. This would have to be a quick visit — she was already late for work.

The mother, Britney WolfVoice, held her newborn son as her three young daughters stood close by. Pipe has been with WolfVoice and her husband for the birth of their newborn son and youngest daughter.

She helped them create delivery plans. For the birth of WolfVoice’s youngest daughter a few years ago, Pipe brought cedar oil, a sacred plant used for prayer, and calmed WolfVoice through her contractions. For the recent birth of her son, when hospital backlogs delayed WolfVoice’s induction, Pipe encouraged her to advocate for an earlier appointment by routinely calling the hospital. Doctors had recommended the procedure to avoid complications.

“Misty is one person who I can count on to be my voice,” WolfVoice said.

If someone needs a ride to a doctor’s appointment, Pipe takes time off work to drive them. If a client goes into labor when Pipe’s at the post office, she texts two other free doulas she knows of on the reservation to see if they have time to help until her shift ends. But they also have day jobs.

Pipe herself has ridden that 100-mile stretch between home and the hospital in labor and in the back of an ambulance. Twice, she gave birth in emergency rooms along the way. In one of her pregnancies, she miscarried at home and couldn’t get a doctor appointment for days.

The long distance to receive care often meant her husband had to stay behind to tend to their other children at home.

“I labored alone so many times,” Pipe said. “I just want to make sure no one’s alone.”

A section of U.S. Route 212 leads to and from Lame Deer, a town in southeastern Montana that is roughly 100 miles from the closest hospital that delivers babies. Nationwide, over 35% of counties don’t have a single birthing facility or obstetric clinician, according to a 2024 report from the March of Dimes. (Katheryn Houghton/��ϳԹ�� News)

Rural maternity care deserts are a , especially as labor and delivery units continue to shutter. In many tribal communities, a lack of care coincides with long-standing inequities caused by centuries of .

Predominantly Indigenous communities face the longest distances to obstetric facilities compared with all other racial and ethnic groups, according to a 2024 report from the March of Dimes. That’s part of the reason Indigenous women are far more likely to get sick from pregnancy and as white women.

Indigenous patients are supposed to be guaranteed access to health care through the federal Indian Health Service. But the chronically underfunded agency has severe gaps. A small fraction of its hospitals and clinics offer labor and delivery. As of 2024, only seven states had either an IHS or tribal birth facility, . To help fill in those shortfalls, Medicaid is the for many Native Americans, according to KFF.

Even where care exists, Native women can experience a distrust of health systems, according to Pipe and other health workers. The U.S. government has a long history of removing children from tribal homes and forcing Native American women to undergo sterilization.

of the Pacific Institute for Research and Evaluation’s Southwest center has studied premature deaths among Native Americans. A member of the Fort Sill-Chiricahua-Warm Springs-Apache Tribe, Haozous said data on maternal health disparities in pregnancy and postpartum often misses a key point.

“It’s not that women are just not taking care of themselves,” Haozous said. “The system is set up for them to not have access to care.”

Pipe sits behind her client, Britney WolfVoice, and WolfVoice’s youngest daughter, Ellie WolfVoice. (Katheryn Houghton/��ϳԹ�� News)

On top of funding cuts, the One Big Beautiful Bill Act will add more frequent eligibility checks and work requirements to access Medicaid. Those changes, when they take effect later this year and next, will lead an estimated 5.3 million people to lose their coverage by 2034.

Native Americans are exempt from some of the law’s new rules, such as the work requirements. Even so, tribal patients can get tangled in administrative hurdles. That includes struggling to enroll in the first place or to prove their tribal status. A full-time college student, WolfVoice said that when she got pregnant, it took about six months to enroll in the state’s Medicaid program.

Despite Montana’s long struggle with a backlogged Medicaid system, state officials aim to implement work requirements this summer, well before the federal deadline.

‘Moccasins on the Ground’

As Pipe pulled into her driveway one day after a full shift at the post office, her kids ran to her. She was also greeted by Felicia Blindman, a 63-year-old public health nurse who used to work for the tribe. The two sat in lawn chairs into the night and brainstormed ways to connect more women to services — such as free prenatal classes.

Pipe’s four youngest children played around them. Her 14-year-old daughter is already certified as an Indigenous doula. Her 8-year-old daughter has begun helping Pipe pick up prescriptions for moms without a car who live out of town. Pipe hopes one day they could do that work full-time, if they want to.

Because of the lost Medicaid payment, Pipe said, she will continue to balance her job with her birth work, even if it means persuading more people to become doulas, such as family and respected community members, to cover more ground.

“It’s not going to stop me from training more birth workers, more young people, more aunties,” Pipe said. “For now, I guess it’s more about grassroots, moccasins on the ground, helping each other.”

She said that means telling pregnant people who walk into the post office she’s there to help if they need support. At least, as long as she’s not at her day job.

Pipe kisses the top of Grover’s head as his father, Torey, scrolls through photos of the baby boy’s namesake grandfather. (Katheryn Houghton/��ϳԹ�� News)

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Lawmakers Seek To Protect Crisis Pregnancy Centers as Abortion Clinic Numbers Shrink

Jazmin Orozco Rodriguez — Thu, 19 Mar 2026 09:00:00 +0000

Conservative lawmakers in multiple states are pushing legislation drafted by an anti-abortion advocacy group to increase protections for crisis pregnancy centers, organizations that provide some health-related services but also work to dissuade women from having abortions.

The legislation would prohibit state and local governments from requiring crisis pregnancy centers to perform abortions, provide referrals for abortion services, or inform patients about such services or contraception options. It also would allow crisis pregnancy centers to sue the violating government entity.

Wyoming lawmakers of the Center Autonomy and Rights of Expression Act, or , on March 4. Other versions have advanced in and this year. One was in 2025. The CARE Act is “model legislation” created by the , an anti-abortion, conservative Christian legal advocacy group.

A similar proposal, the , was introduced in Congress last year but hasn’t moved out of the House Energy and Commerce Committee.

The Wyoming bill says that pregnancy centers, many of which are affiliated with religious organizations, need legal protection after facing “unprecedented attacks” following the Supreme Court’s overturning of Roe v. Wade. It says that several state legislatures have introduced bills that . Opponents of these centers say they falsely present themselves to consumers as medical clinics, though they are not subject to state and federal laws that protect patients in medical facilities.

“Across the country, government officials are increasingly, increasingly targeting pregnancy care centers,” Valerie Berry, executive director of the in Cheyenne, said at a February legislative hearing on the Wyoming bill. “This legislation is not about creating division. It’s about protecting constitutional freedoms, freedom of speech, and freedom of conscience.”

Wyoming state , a Republican, expressed concern at the hearing about granting protections to pregnancy centers that other private businesses do not have.

“They have protections in place,” he said. “My issue with this is giving extra special protections.”

In 2022, Wellspring Health Access, the only clinic in Wyoming that provides abortions, in an arson attack.

“We are the ones providing the accurate information on reproductive health care, and we suffer the consequences for that,” Julie Burkhart, the president and founder of Wellspring Health Access, told ��ϳԹ�� News.

, a professor at the University of California-Davis School of Law, said the proposed legislation would insulate crisis pregnancy centers from having to meet the standards that medical organizations face. It would blur the line between advocacy and medical practice, she said. And such legislation provides Republicans with a potentially useful campaign message ahead of midterm elections.

“The GOP needs a messaging strategy as for how it cares about women even if it bans abortion and even if it doesn’t want to commit state resources to helping people before and after pregnancy,” Ziegler said. “The strategy is to outsource that to pregnancy counseling centers, which of course increases the incentive to protect them.”

Model Legislation

The Alliance Defending Freedom is the same group that , the 1973 court ruling that protected the right to abortion nationwide. The group drafted model legislation to establish a 15-week abortion ban that was the basis of a 2018 Mississippi law. That led to the Dobbs v. Jackson Women’s Health Organization Supreme Court case that overturned Roe.

The alliance said its attorneys were unavailable to comment on the organization’s strategy for the CARE Act. In for the bill, the group said federal, state, and local efforts are targeting pregnancy care centers in a “clear attempt to undermine and impede” their work and shut them down.

In recent years, have been targeted with vandalism and threats.

But the attacks the model legislation primarily aims to address are the legal and regulatory efforts by some states seeking more oversight of the crisis pregnancy centers, including a California law requiring centers to clearly inform patients about their services. That law was overturned when the Supreme Court ruled in favor of crisis pregnancy centers’ argument that it violated their First Amendment rights.

The Supreme Court is that will decide whether states can subpoena the organizations for donor and internal information.

It’s unlikely that crisis pregnancy centers would face such regulatory measures in the conservative states where the legislation is under consideration. One Wyoming lawmaker acknowledged that in the February committee hearing.

Differing Services

During that hearing, state , a Republican who heads the committee sponsoring the bill, presented the measure as “so important, especially with our maternity desert,” referring to a lack of access to maternity health care services.

Some crisis pregnancy centers may have a few licensed clinicians, but many do not. Many offer free resources, such as diapers, baby clothing, and other items, sometimes in exchange for participation in counseling or parenting classes.

Planned Parenthood clinics, by contrast, provide a range of health services, such as testing and treatment for sexually transmitted infections, primary care, and screenings for cervical cancer. They also are regulated as medically licensed organizations.

Since Roe was overturned, the abortion rights movement has faced significant challenges. Congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, to abortion providers. The move contributed to Planned Parenthood closing last year.

As of 2024, operated nationwide, according to a map created by researchers at the University of Georgia, compared with providing abortions at the end of 2025.

a research organization affiliated with the anti-abortion nonprofit SBA Pro-Life America, has suggested that pregnancy centers could help fill the gap left by the Planned Parenthood closures.

Ziegler said that would leave patients vulnerable to medical risks.

Centers’ Growing Power

Previous efforts in , Colorado, and Vermont to regulate crisis pregnancy centers arose from concerns over allegations of and questions about .

In 2024, in five states to investigate whether centers were misleading patients into believing that their personal information was protected under the Health Insurance Portability and Accountability Act, known as HIPAA, and to find out how the centers were using patients’ information.

Courts, including the Supreme Court, have regularly that argue the attempts at regulation are violations of their First Amendment rights to free speech and religious expression.

Crisis pregnancy centers also have seen a flood of funding since Roe was overturned.

At least , including crisis pregnancy centers, according to the Lozier Institute.

Six states distribute a portion of their federal Temporary Assistance for Needy Families funding — cash payments meant for low-income families with children — to crisis pregnancy centers. Texas, Florida, Tennessee, and Oklahoma have provided tens of millions of dollars for the organizations.

One analysis found that crisis pregnancy centers also received from 2017 to 2023, including from the 2020 relief package signed into law during Trump’s first term amid the covid pandemic.

Despite the challenges clinics that provide abortions face, Burkhart, the head of the Wellspring facility in Wyoming, said it’s important to continue offering access to people who need it. She’s helped open clinics in rural parts of other conservative states and said those clinics continue to see people walking through their doors.

“That proves to me, regardless of your religion, political party, there are times in people’s lives that people need access to qualified reproductive health care,” she said. “That includes abortion.”

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Journalists Explain a Spat Over Sugary Coffee and How Measles Fools Doctors

Sat, 07 Mar 2026 10:00:00 +0000

��ϳԹ�� News senior correspondent Renuka Rayasam discussed excited delirium on Vox Media Podcast Network’s Criminal on March 6.

Read Rayasam’s ““

On CBS News’ CBS Mornings on March 5, Céline Gounder, ��ϳԹ�� News’ editor-at-large for public health, discussed the Massachusetts governor’s retort to comments by Health and Human Services Secretary Robert F. Kennedy Jr. about popular coffee chains.

��ϳԹ�� News California correspondent Christine Mai-Duc discussed Affordable Care Act premium increases on CapRadio’s Insight With Vicki Gonzalez on March 2.

Read Mai-Duc’s ““

��ϳԹ�� News rural health reporter Andrew Jones discussed how younger doctors are struggling to diagnose measles on KMOX’s Total Information AM on Feb. 27.

Read Jones’ “.”

��ϳԹ�� News South Dakota correspondent Arielle Zionts discussed the $50 billion Rural Health Transformation Program on Marketplace’s Make Me Smart podcast on Feb. 19.

Read Zionts’ “,” co-reported with Sarah Jane Tribble and Maia Rosenfeld.

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ICE, ALS, Addiction Medicine, and Robotic Ultrasounds: Journalists Sound Off on All That and More

Sat, 28 Feb 2026 10:00:00 +0000

��ϳԹ�� News Southern California correspondent Claudia Boyd-Barrett discussed how family members and lawyers of those in Immigration and Customs Enforcement custody are struggling to find them in California hospitals on CapRadio’s Insight With Vicki Gonzalez on Feb. 25.

Click here to hear Boyd-Barrett on .
Read Boyd-Barrett’s “‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees.”

Céline Gounder, ��ϳԹ�� News’ editor-at-large for public health, discussed the neurodegenerative disease ALS on CBS News’ CBS Mornings on Feb. 20.

��ϳԹ�� News senior correspondent Aneri Pattani discussed Elyse Stevens, a New Orleans doctor who faced investigation because of her patient-centered approach to substance use disorders, on The Lens’ Behind The Lens podcast on Feb. 20.

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Read Pattani’s “Inside the Battle for the Future of Addiction Medicine.”

��ϳԹ�� News chief rural correspondent Sarah Jane Tribble discussed major cuts to Medicaid on WBUR’s Here & Now on Feb. 19. Tribble also discussed Alabama’s plan for robotic ultrasounds on The Daily Yonder’s The Yonder Report on Feb. 19.

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Read Tribble’s “Alabama’s ‘Pretty Cool’ Plan for Robots in Maternity Care Sparks Debate.”

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New Orleans Brings Back the House Call, Sending Nurses To Visit Newborns and Moms

Rosemary Westwood, WWNO — Mon, 23 Feb 2026 10:00:00 +0000

When Lisa Bonfield gave birth to daughter Adele in late November, she was thrust into the new world of parenting, and faced an onslaught of challenges and skills to learn: breastfeeding, diapering, sleep routines, colic, crying, and all the little warning signs that something could be wrong with the baby.

But unlike parents in most of the U.S., she had extra help that was once much more common: house calls.

Adele was only a few weeks old when a registered nurse showed up at Bonfield’s door on Dec. 10 to check on them and offer hands-on help and advice.

As a city resident who had recently given birth, she was eligible for up to three home visits from , a program of the city health department.

She didn’t need to feed and change the baby before packing everything up for a car trip to the pediatrician or a clinic. It was a relief; Bonfield was exhausted and was still trying to figure out how to use the infant car seat.

“Everything is so abstract before you have a baby,” Bonfield said. “You are going to have questions you never even thought about.”

Louisiana is among the worst-performing states in maternal and infant health outcomes. So New Orleans is trying to catch health issues early — and get families off to an easier start — by adding health visits during the crucial first months of life.

The hope is that health outcomes can be improved by returning to the old-fashioned medical practice of house calls.

The Family Connects model has been tried in communities . It began in Durham, North Carolina, in 2008, as a partnership with Duke University. In 2023, New Orleans’ health director, , helped launch a local version of the program.

Avegno was concerned by Louisiana’s particularly grim statistics for maternal and infant health.

The state has some of the highest rates of preterm births, unnecessary cesarean sections, and maternal and infant deaths, according to the . A from the United Health Foundation found that Louisiana was the “least healthy” state for women and children.

“We got to do some real things real differently, unless you like being No. 50 all the time,” Avegno said.

The home visits are free and available to anyone who has just given birth in a New Orleans hospital, no matter their insurance status or income level.

Avegno describes the home visits as going “back to the future,” replicating a practice that was far more common a hundred years ago.

“There is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth,” Avegno said.

The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city.

They ask if the family has enough food, and whether there are guns in the house and how they’re stored, Avegno said.

In Bonfield’s case, the nurse stayed for over two hours. Bonfield especially liked their conversation about how to safely store breastmilk.

“I’ve never felt so well taken care of and listened to,” she said.

Broad Support

Louisiana has struggled a long time with poor maternal and infant health outcomes, but the problem has been complicated by the .

The 2022 law led to risky medical delays and in obstetrical care, and confusion among doctors about what’s allowed in ending dangerous pregnancies or .

Avegno opposes the state’s abortion policies, believing they are harmful to women’s health. But she says that Family Connects offers other ways to preserve and expand care for women. For example, the visiting nurse can check in with the mother about whether she needs help with birth control.

“We can’t give them abortion access,” she said. “That’s not the goal of this program, and that wouldn’t be possible anyway. But we can make sure they’re healthy and understand what their options are for reproductive health care.”

Abortion politics aside, the postpartum home visits seem to have bipartisan support in Louisiana, and state lawmakers want to expand their availability.

Last year, the Republican-dominated legislature requiring private insurance plans to cover the visits.

The new law is another way that Louisiana officials can be “pro-life,” said state , who, as a Republican and an abortion opponent, sponsored the legislation.

“One of the slings used against advocates against abortion is that we’re pro-birth, and not truly pro-life,” Bayham said. “And this bill is proof that we care about the overall well-being of our mothers and our newborns.”

Improving Health and Help for Postpartum Depression

Two years in, there are already promising signs that the program is improving health.

Early data analyzed by researchers at Tulane University showed that families who got the visits were more likely to stick to the recommended schedule of pediatric and postpartum checkups. Moms and babies were also less likely to need hospitalization, and overall health care spending was down among families insured by Medicaid.

Research on Family Connects programs elsewhere has found similar results. In North Carolina, one study showed that three to seven home visits in the year before a baby turned 1.

But the statistic that most excited Avegno related to the program’s role in screening mothers for postpartum depression.

The visiting nurses are helping spot more cases of postpartum depression — earlier — so that new moms can get treatment. About 10% of moms participating in the New Orleans program were eventually diagnosed with postpartum depression, compared with 6% of moms who did not get the visits.

Timely diagnosis is important to prevent depression symptoms from worsening, or leading to more , such as suicidal thoughts, thoughts of harming the baby, or problems bonding with their newborn.

Lizzie Frederick was one of the New Orleans mothers whose postpartum symptoms were caught early by a visiting nurse.

When she was pregnant, she and her husband took all the childbirth and newborn classes they could. They hired a doula to help with the birth. But Frederick still wasn’t prepared for the stresses of the postpartum period, she said.

“I don’t think there are enough classes out there to prepare you for all the different scenarios,” Frederick said.

When her son, James, was born in May, he had trouble breastfeeding. He was sleeping for only 90-minute stretches at night.

When the nurse arrived for the first visit a few weeks later, Frederick was busy trying to feed James. But the nurse reassured her that there was no rush. She could wait.

“I am here to support you and take care of you,” Frederick recalled the nurse saying.

The nurse weighed James, and Frederick was relieved to learn he was gaining weight. But for most of the visit, the nurse focused on Frederick’s needs. She was exhausted, anxious, and had started hearing what she called phantom cries.

The nurse walked her through a mental health questionnaire. Then she recommended that Frederick see a counselor and consider attending group therapy sessions for perinatal women.

Frederick followed up on these suggestions and was eventually diagnosed with postpartum depression.

“I think that I would have felt a lot more alone if I hadn’t had this visit, and struggled in other ways without the resources that the nurse provided,” Frederick said.

Home Visits Save Money

, an assistant professor at Tulane’s School of Public Health, helped interview over 90 families participating in the Family Connects New Orleans program.

“It was overwhelmingly positive experiences,” she said. “This is like a gold-standard public health project, in my opinion.”

To operate, Family Connects costs the city about $1.5 million a year, or $700 per birth, according to Avegno. But the program also has the potential to save money: Research on North Carolina’s program in the program saved $3.17 in health care billing before the child turned 2.

That’s another reason to require the visits statewide, according to state Rep. Bayham.

“The nurses and medical practitioners will be able to monitor potential problems on the front end, so that they could be handled without a trip to the emergency room or something even more drastic,” he said.

Avegno is advocating that the program be included in Louisiana’s Medicaid program, since more than in the state are covered by Medicaid. A recent made the same recommendation.

This article is from a partnership that includes , , and ��ϳԹ�� News.

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Alabama’s ‘Pretty Cool’ Plan for Robots in Maternity Care Sparks Debate

Sarah Jane Tribble — Thu, 12 Feb 2026 10:00:00 +0000

It sounds like something from a science fiction novel, but Alabama officials’ plan to use robots to improve care for rural pregnant women and their babies is real.

During a January White House roundtable touting the first grants to states under a new $50 billion rural health fund, Centers for Medicare & Medicaid Services Administrator Mehmet Oz called the idea “pretty cool.” Later that day, Sen. Bernie Sanders, the independent from Vermont, said it is decidedly . And obstetricians and others chimed in on social media to express alarm, with one political activist calling it a “.”

The disparate responses highlight how excitement over the tech-heavy ideas states pitched in their applications for the federal Rural Health Transformation Program conflicts with the reality that there simply aren’t enough health workers to serve patients in many rural communities. Now, as states prepare to spend their first-year awards, tension is mounting, and nowhere is that strain more visible than in Alabama.

Oz has lauded the state’s proposal to invest in the relatively new technology of robotic ultrasounds.

“Alabama has no OB-GYNs in many of their counties,” Oz said, sitting with President Donald Trump and Cabinet members. The dearth of care, , prompted the proposal to use robots for ultrasounds on pregnant women.

Britta Cedergren directs the and has a firm grip on reality: “No one is using autonomous robots.”

While robotic ultrasounds are a “really neat technology,” she said, they are not yet being used in the state. Instead, clinicians providing obstetric care lean on phone consultations and — when equipment and internet are available — telehealth.

The goal, she said, is to “support places where there is no care.”

Cedergren is part of multiple state maternal and fetal health groups and works daily with doctors, hospitals, and first responders. While enhanced technology is vital for patient care, it’s not a replacement for a well-trained workforce and a coordinated care and data system, she said.

In 2024, the most recent year for which data is available, Alabama’s infant mortality rate was per 1,000 live births. The nationwide rate was 5.5 per 1,000 live births, according to released by the Centers for Disease Control and Prevention.

Hospital-based obstetric unit closures, which often lead to a loss of health care providers who can care for expectant mothers and their babies, are a long-standing, ongoing trend in rural America. But Alabama’s loss of services has been particularly profound.

In 1980, 45 of the state’s 55 rural counties had hospital-based obstetric services. By 2025, , according to state data. And the losses aren’t slowing. Five hospital obstetric units closed in 2023 and 2024, including in three rural counties: Monroe, Marengo, and Clarke.

Julie Fontaine works for the Virtual Health Hub, operating a robotic ultrasound in the remote village of La Loche, Saskatchewan.

, a professor at the University of Minnesota School of Public Health, found that closures in remote areas in preterm births, a leading cause of infant mortality.

“People will be pregnant and give birth in communities all over the place,” she said. “You have to be able to get to a place where you can be cared for.”

Nearly all 50 states’ applications for the Rural Health Transformation Program declared workforce shortages and maternal health needs as priorities, but only Alabama proposed using robots to fill the gap. The rural fund, which Congress created as a last-minute sweetener in Trump’s One Big Beautiful Bill Act last summer, encouraged states to be creative, be innovative, and pitch tech solutions.

Alabama was awarded $203 million for the first of the program’s five years. Among nearly a dozen , the state’s application included bolstering its rural workforce as well as improving maternal and fetal health.

Mike Presley, a spokesperson for the , which is overseeing the plan, said no one was available for an interview about telerobotic ultrasounds.

LoRissia Autery, an obstetrics and gynecology specialist in rural Alabama northwest of Birmingham, said the robots won’t decrease maternal and infant mortality. There are nuances, she said, to doing ultrasounds.

Many of her patients have high-risk pregnancies with diabetes, high blood pressure, and hepatitis C, she said. She said she worries about the kind of care that will be given to her patients, many of whom drive an hour or more to get to her, if robots are used instead of a trained specialist.

“It takes away just the care that we need to have for women,” said Autery, who co-founded . The clinic includes three doctors, draws patients from five counties, and could use an additional physician to meet the demand, Autery said.

“Probably for the past six or seven years, we’ve been putting out feelers trying to find a fourth partner,” Autery said. “It’s difficult for a variety of reasons.”

In his social media remarks to Oz, Vermont’s Sanders called the lack of rural health care providers in the U.S. an “international embarrassment.”

“In the richest country on earth, we need more doctors, nurses, dentists and mental health counselors, not more robots,” Sanders wrote on the social platform X.

At least one country is using robots paired with trained workers to decrease deaths.

In the remote Canadian village of La Loche, Julie Fontaine operates an ultrasound robot at a clinic with two on-site nurse practitioners and rotating doctors. She said patients like the robot because it saves them the time and expense of traveling to a bigger regional health care facility six to seven hours away.

“When people come in, they’re like, ‘Wow, like, technology these days,’” said Fontaine, a member of the in northern Saskatchewan. “It’s something they’ve never seen before or even used.”

A robotic arm, remotely controlled by a sonographer hours away, scans a patient in Saskatchewan, Canada. (Virtual Health Hub)

When working with patients, Fontaine connects the robotic ultrasound machine to a tele-sonographer at a control station in Saskatoon. The sonographer then remotely operates a robotic arm on the machine. A radiologist, who can be anywhere, reads the scan’s report and sends it back to the family doctor in La Loche, said Ivar Mendez, a neurosurgeon and the director of Canada’s . Most babies in Canada, he said, are delivered by family doctors or midwives, not specialists.

“The most important thing is the identification of a high-risk pregnancy early enough so you can intervene,” said Mendez, who added that the robotic ultrasound is “as good as the in-person ultrasound” but can’t be used when a patient needs a more invasive vaginal ultrasound. The mortality rate for mothers and newborns in the north, site of the La Loche clinic, is 20 to 25 times greater than in the rest of the nation, he said.

“One of the reasons is that there’s no availability of prenatal ultrasonography in those communities, so pregnant women have to travel to cities and they’re put up at hotels,” he said.

In a , Mendez and his team at the University of Saskatchewan examined 87 telerobotic ultrasounds and found that 70% of the time, the robotic ultrasound made travel for care unnecessary. Nearly all the patients said they would use the robot again.

The same robotic ultrasound technology was in the U.S.

Nicolas Lefebvre, chairman and chief executive of the robot’s creator and manufacturer, AdEchoTech, said the company has “U.S. maternity-specific projects that are currently under preparation.” The average price of a robot will be $250,000 to $350,000, according to AdEchoTech’s U.S.-based business development consultant.

Using robotic ultrasounds is one part of Alabama’s proposed maternal and fetal health initiative, according to the . Acknowledging loss of hospital obstetric units, officials said they planned to connect smaller rural providers and health care facilities that lack “high-quality maternal and fetal health services” to regional care hubs that can provide the services digitally, including through telerobotic ultrasound.

For their workforce initiative, state officials proposed training programs for doctors, emergency services, and nurse-midwives.

The estimated required funding for the maternal and fetal health initiative is . Alabama officials proposed for their workforce initiative over five years.

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If You’re Pregnant and Uninsured, Medicaid Might Be Your Answer

Blake Farmer, Nashville Public Radio — Tue, 03 Feb 2026 10:00:00 +0000

LISTEN: If you’re newly pregnant and not able to afford health insurance, you may qualify for Medicaid. Reporters Cara Anthony and Blake Farmer — hosts of the new series “HealthQ” — explain that every state has a program to provide coverage for pregnant people.

When she noticed an unusual craving for hot dogs, Matte’a Brooks suspected her body was telling her something, so she decided to take a pregnancy test. She took two just to be sure. Both were positive.

“I was definitely scared,” said Brooks, 23, who was uninsured. “I was like, OK … I’m pregnant, so where do I go from here?”

Until then she hadn’t thought much about health care, but that changed when she found out that her daughter was on the way.

Brooks got that news last winter. The mix of joy, anxiety, and excitement she felt mirrors what many new parents feel at this time of year. Many Americans find out in January or February that they’re expecting, because in the U.S., August has consistently high birth rates.

A growing body of research shows that prenatal care can make a huge difference to the long-term health of both the parent and baby. This is part of why offers health coverage to pregnant women who meet income requirements and might otherwise go uninsured.

As a result, Medicaid pays for more than 40% of births in the U.S. and an even higher percentage in rural areas, according to KFF. But Medicaid also comes with limitations, and providers may restrict how many Medicaid patients they take, since the payments are than other insurers’.

Here are three things to know about signing up for Medicaid when pregnant.

1. Pregnancy Makes You a Priority

To sign up for government health care, you have to meet a number of requirements that vary widely by state. Most importantly, your income has to be below a certain threshold. In several states, most adults cannot qualify, regardless of income, if they’re not disabled or the parent of a child.

But the math is different for pregnancy. In Tennessee, for example, the eligibility cutoff in pregnancy is the income threshold for some other residents. So if you didn’t qualify for Medicaid previously and are now pregnant, it’s worth double-checking your state’s requirements.

2. Getting Covered Can Be Surprisingly Easy

To apply, you’ll likely proof of income, your Social Security number, and proof of residency. Brooks, an Illinois resident, told HealthQ that she found the sign-up process surprisingly easy. She learned about Medicaid from the provider at her initial prenatal visit.

“They asked if I had insurance. I didn’t know anything at the time,” she said. The nonprofit clinic gave her some phone numbers for the state Medicaid agency. She called and went to an in-person appointment to complete her application. She walked out of the office with coverage. In , pregnancy results in “presumptive eligibility,” which provides immediate coverage — even without confirmation of the pregnancy — while the application goes through the approval process.

3. Coverage Can Go Beyond Standard Medical Care

Medicaid provides all prenatal care at no out-of-pocket cost and usually a of postpartum care. That’s what happened to Brooks: Her appointments, medications, and delivery were free.

States cover dental, vision, and mental health care to varying degrees. Ashley Farrell, who lost her job when she was pregnant and applied to Medicaid in Georgia, said she received “rewards for going to your appointments,” including . Benefits vary by state.

People and Policy

Some maternal health advocates about how Medicaid cuts in the One Big Beautiful Bill Act will affect pregnancy coverage. Though it’s unclear when or how, states might scale back eligibility or offerings for expectant mothers.

Katherine Ruppelt at Nashville Public Radio contributed to this report.

HealthQ is a health series from reporters Cara Anthony and Blake Farmer — approachable guides to an unapproachable health care system. It’s a collaboration between Nashville Public Radio and ��ϳԹ�� News.

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Journalists Mine News for Insights on Tylenol, Obamacare Credits, and Rural Health Funding

Sat, 24 Jan 2026 10:00:00 +0000

Céline Gounder, ��ϳԹ�� News’ editor-at-large for public health, discussed a year of changes at the Department of Health and Human Services and its Centers for Disease Control and Prevention on NPR’s 1A on Jan. 22. On CBS News 24/7’s The Daily Report on Jan. 16 and CBS Saturday Morning’s HealthWatch on Jan. 17, Gounder also discussed a study that found no link between acetaminophen use during pregnancy and autism or attention-deficit/hyperactivity disorder. She also commented on rising measles cases and decreasing vaccination rates on CBS News 24/7’s The Daily Report on Jan. 15.

��ϳԹ�� News California correspondent Christine Mai-Duc discussed the expiration of enhanced Affordable Care Act subsidies on LAist’s AirTalk on Jan. 20.

��ϳԹ�� News chief rural correspondent Sarah Jane Tribble discussed the new Rural Health Transformation Program on Community Health Center Inc.’s Conversations on Health Care on Jan. 8.

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Read the ��ϳԹ�� News series “Rural Health Payout: Tracking the $50B Rural Health Fund.”

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Montana Moves Ahead With Doula Pay but Warns Medicaid Cuts Still May Come

Khnkatherynh — Wed, 22 Apr 2026 09:00:00 +0000