SF3768

Purpose

This bill would require Minnesota health plans to cover doula services and would modify how doula coverage is handled in the state’s Medical Assistance program. It also creates a state funding mechanism to reimburse health plans for the added costs of providing this coverage, starting in fiscal year 2028.

Main provisions

• Definitions

  • Certified doula: a doula certified under section 148.995 (the bill defines who is covered).
  • Doula services: childbirth education and support provided during pregnancy, labor, birth, and the postpartum period.
  • Childbirth education and support services: the emotional and physical support offered during the childbirth process.

• Required coverage

  • All health plans must cover doula services.

• Cost-sharing (out-of-pocket costs)

  • Health plans may not apply any cost-sharing to this coverage. This means no deductible, copayment, or coinsurance for doula services.

• Review and referral limitations

  • No utilization review, referral requirements, or delay periods can be imposed for this coverage.

• Quantity limitations

  • No limits on the amount of doula services that can be covered.

• Application rules (deductible interaction)

  • If applying these provisions would affect eligibility for a health savings account (HSA) under 26 USC 223 or for a catastrophic health plan under 42 USC 18022e, then the doula coverage takes effect only after the enrollee has met their health plan deductible.

• Reimbursement by the state

  • The Minnesota Commissioner of Commerce must reimburse health plan companies for the added coverage, per 45 CFR 155.170.
  • Reimbursement is limited to coverage that the plan would not have provided without these requirements.
  • Payments cannot cover treatments/services/supplies/equipment that the plan was already covering as of January 1, 2026.
  • Health plans must report quantified costs attributable to this new benefit in a format the commissioner specifies.
  • The plan’s coverage as of January 1, 2026 is used as the baseline to determine whether the plan would not have provided the coverage otherwise.
  • The commissioner will evaluate submissions and make payments under 45 CFR 155.170.

• Appropriation and funding

  • Beginning in fiscal year 2028, an amount necessary to make these defrayal payments is appropriated from the general fund to the Commissioner of Commerce.
  • The appropriation includes funding for the commissioner’s administrative costs to administer the defrayal payments.

• Relationship to existing statutes

  • The bill also aims to modify doula coverage language in the Minnesota Medical Assistance (MA) program (Minnesota Statutes 2024 section 256B.0625, subdivision 28b).

Significant changes to existing law

• Introduces mandatory doula coverage across health plans in Minnesota, with no cost-sharing and no certain review/referral hurdles.
• Establishes a state reimbursement mechanism to offset health plans’ added costs, funded by the general fund starting in 2028.
• Ties the coverage to federal rules (CFR 45.155.170) and federal tax/insurance standards (HSAs and catastrophic plans) to determine when coverage applies.
• Modifies MA program language to include doula services.

Potential implications

• Access: Increased access to doula support during pregnancy, labor, and the postpartum period.
• Costs: Higher costs for health plans, offset by state reimbursements beginning in 2028.
• Public programs: Expanded doula coverage in the Medical Assistance program.
• Compliance: Health plans and the state must handle new reporting and baseline comparisons tied to 2026 coverage.

Relevant Terms - doula services - certified doula - childbirth education and support services - mothers choice - health plans - coverage - cost-sharing - deductible - copayment - coinsurance - utilization review - referral - delay period - quantity limitation - United States Code title 26 section 223 - United States Code title 42 section 18022e - Health Savings Account (HSA) - Code of Federal Regulations title 45 section 155.170 - Commissioner of Commerce - general fund - fiscal year 2028 - Minnesota Medical Assistance program (MA) - Minnesota Statutes 2024 section 256B.0625 subdivision 28b