House Health Care panel amends S.53 to require Medicaid state-plan amendment for doula coverage by July 1, 2026

The Vermont House Health Care Committee on May 8 approved an amendment to S.53 that directs the Department of Vermont Health Access to seek a Medicaid state plan amendment to provide permanent Medicaid coverage for doula services no later than July 1, 2026, and sets the statute’s effective date as the later of July 1, 2026, or approval of that state plan amendment.

Committee member Representative Gina, who introduced the amendment language, said the change was intended to remove ambiguity about whether a state plan amendment was required and to give the agency a firm deadline. "This would say not later than July first of 20 26. The Department of Vermont Health Access shall seek a state plan amendment," she said, adding she removed language saying "if needed" because "we understand it is" needed.

The amendment replaces the bill’s original Section 7 with a version that requires the Department of Vermont Health Access to request a SPA from the Centers for Medicare and Medicaid Services (CMS) "to allow Vermont's Medicaid program to provide coverage for doula services in accordance with" the statutory provision added by S.53. It also revises the effective-date language so coverage would begin on the later of 07/01/2026 or approval of the SPA requested under the new Section 7.

Jen Carby of the Office of Legislative Council, who posted the draft amendment to the committee page, walked members through the side-by-side language and confirmed the changes were limited to adding the July 1, 2026, deadline and removing the bill’s prior conditional language about whether a SPA "is needed." Carby said the revised effective-date clause clarified that coverage would take effect upon the later of the statutory date or federal approval of any required SPA.

A Department of Vermont Health Access staff member who identified themself for the record as Allison Cracking said the agency "view this as a big step in the right direction" and appreciated the amendment because the federal environment is "tumultuous" and the change provides flexibility in timing. "We wanna exercise every caution available to us, and we appreciate a change in the amendment," the speaker said, while also noting the comment did not represent a change in the department’s position on other outstanding issues in the bill.

Committee discussion emphasized that the amendment is intended to allow rulemaking and certification work for community-based doulas to proceed while giving the agency time to assess federal budget and CMS guidance. "It gives them some time to come back and say stop. Don't do this if it's really gonna be dangerous," a committee member said during questions about implementation and fiscal timing.

The committee took a straw poll on whether to adopt the amendment (draft 1.1) and reported the result as 11–0 in favor. The committee then voted to report S.53 "favorably" as amended; the motion was seconded and passed on a roll call with yes votes recorded from Representative Tina, Representative CripSpot, Representative Demora, Representative Paige, Representative Powers, Representative Rebecca, Representative Hickon, Representative Black and other members present. Representative Black, explaining a yes vote, said, "I'm voting yes in honor of Representative Cortes," and asked to be named the bill reporter.

Members and staff repeatedly noted that the bill will next go to the Legislature’s money committees — Ways and Means and Appropriations — where budget impacts and fiscal details will be considered. Committee members also said the amendment does not resolve all outstanding fiscal questions that the Department of Vermont Health Access raised; the department can return in the next legislative session if it needs more time or information.

Next steps for S.53 are referral to the House clerk for transmittal to Ways and Means and Appropriations and continued consideration of fiscal details and any required federal approvals. The amendment allows the certification and rulemaking processes for a subset of doulas to proceed while pausing the fiscal implementation until the SPA is sought and, if needed, approved.

The committee’s discussion and the department’s comments occurred during the S.53 agenda item; public-comment periods were not part of the record for this item.