HF3779

Purpose

• Expand access to doula services by requiring health plans to cover them.
• Update how Minnesota’s Medical Assistance program (Medicaid) handles doula coverage.
• Create a state-funded reimbursement program to help health plans offset the added cost.
• Begin funding for reimbursements in a future fiscal year.

Key terms and definitions

• Certified doula: a doula as defined by Minnesota statute (section 148.995, Mothers Choice).
• Doula services: childbirth education and support provided by a certified doula.
• Childbirth education and support services: the emotional and physical support during pregnancy, labor, birth, and the postpartum period.
• Health plans: the various private or group health insurance plans offered in Minnesota.

What the bill requires of health plans

• All health plans must cover doula services (no exceptions listed for plan type).
• No cost-sharing can be charged for this coverage, including:
  • Deductibles
  • Copayments
  • Coinsurance
• No review or referral barriers to this coverage, including:
  • Utilization review
  • Referral requirements
  • Delay periods
• No quantity limits on the coverage (i.e., no cap on the number of doula visits or services).

Application nuances and deductible interaction

• If applying the coverage before a enrollee meets their plan deductible would cause issues with health savings accounts (HSAs) or catastrophic health plan eligibility, the coverage under this bill applies only after the enrollee has met the deductible. (References to HSA eligibility under 26 U.S.C. § 223 and catastrophic plan eligibility under 42 U.S.C. § 18022e.)

Reimbursement and funding (how the state helps insurers)

• The commissioner of commerce must reimburse health plan companies for the added coverage, following the rules in Code of Federal Regulations Title 45, Section 155.170.
• Reimbursement only covers coverage that would not have been provided by the plan without these new requirements.
• Plans cannot be reimbursed for services and items already covered by the plan as of January 1, 2026.
• Plans must report to the commissioner quantified costs attributable to the new benefit in a format the commissioner develops.
• The plan’s February 1, 2026 coverage baseline must be used to determine whether a given coverage would not have been provided without the new requirements.
• The commissioner will review submissions and make payments per CFR Title 45, Section 155.170.

Funding timeline and administration

• Beginning in fiscal year 2028, an amount needed to pay the added coverage costs will be appropriated from Minnesota’s general fund to the commissioner of commerce.
• The appropriation must cover both the payments to health plans and the administrative costs for administering the defrayal payments.

Significant changes to existing law

• Creates a new mandatory coverage requirement: all health plans must cover doula services.
• Establishes explicit no-cost-sharing and no-review/limit protections for this coverage.
• Adds a state reimbursement mechanism to offset insurer costs for the new coverage, with specific eligibility and reporting requirements.
• Modifies Minnesota’s approach to doula coverage in the Medical Assistance program (Medicaid) through related amendments.
• Institutes a new funding stream (general fund) starting in FY 2028 to support the reimbursement program.

Relevant terms - doula services - certified doula - childbirth education and support services - health plans - commissioner of commerce - utilization review - deductible - copayment - coinsurance - United States Code (U.S.C.) references: 26 U.S.C. § 223; 42 U.S.C. § 18022e - Code of Federal Regulations (CFR) Title 45 § 155.170 - Minnesota Statutes 2024 § 256B.0625 subd. 28b - Minnesota Statutes Chapter 62Q - Medical Assistance program - appropriation (general fund) - fiscal year (FY) 2028 and beyond