HB5406 would amend the Health Profession Opportunity Grant Program (SSA section 2008) to create a new subsection that authorizes grants for demonstration projects designed to educate and train eligible individuals for career pathways in pregnancy, childbirth, or postpartum. Grants would be awarded to eligible entities to operate these projects in states that recognize doulas or midwives and provide payment for such services under private or public health insurance plans.
The projects must run for at least three years and include rigorous evaluation to identify what works for expanding access and advancing workforce development. The bill also defines who counts as an eligible entity or individual, lays out evaluation expectations, and provides a $10 million appropriation for fiscal year 2026, with an effective date of October 1, 2025.
At a Glance
What It Does
The Secretary may award grants to eligible entities to fund demonstration projects that educate and train individuals for careers in pregnancy, childbirth, or postpartum under HPOG. Projects must operate in States recognizing doulas/midwives and paying for their services through insurance.
Who It Affects
Eligible entities include local workforce boards under WIOA, States or subdivisions, tribes, IHEs, hospitals, FQHCs, skilled nursing facilities, federally qualified health centers, 501(c)(3) nonprofits, labor organizations, and other health-profession-training providers. Eligible individuals earn at or below 138% of the Federal poverty level.
Why It Matters
This program aims to build a formal pipeline for maternal-care careers, expand access to doula and midwife services, and improve workforce diversity and education standards, backed by a rigorous evaluation framework to measure outcomes and sustainability.
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What This Bill Actually Does
The bill adds a new grant authority to the Health Profession Opportunity Grant Program. It allows the Secretary to award grants to a broad set of eligible entities to run demonstration projects that educate and train individuals to pursue career paths in pregnancy, childbirth, or postpartum care.
Projects must occur in states that recognize doulas or midwives and that provide payment for such services through insurance, whether private or public. Each project must run for at least three years and include a plan to recruit and train workers who largely come from low-income backgrounds.
Applicants must show they can work within the state’s rules for doulas and midwives and partner with organizations that have experience serving low-income populations. The bill defines who is eligible to lead projects, who can be trained, and what counts as a midwife, doula, or tribally-recognized midwife.
A new appropriation of $10 million is authorized for FY2026, and the program takes effect October 1, 2025. The goal is to establish clear pathways, better wages, and health coverage for participants and to generate rigorous evaluations of what works in building this workforce.
The Five Things You Need to Know
The bill creates a new subsection under the Health Profession Opportunity Grant Program to fund demonstration projects for pregnancy-care career pathways.
Projects must run for at least 3 years and operate in states that recognize doulas or midwives and cover their services.
Eligible entities include a broad set of actors (workforce boards, tribes, hospitals, IHEs, FQHCs, nonprofits, and more).
Eligible individuals must have income no greater than 138% of the Federal poverty level.
A $10,000,000 appropriation is provided for FY2026, with an effective date of October 1, 2025.
Section-by-Section Breakdown
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Grant authority and objective
Section 2 adds a new demonstration-project authority under the Health Profession Opportunity Grant Program. The Secretary, in coordination with the Labor and Education Secretaries, may award grants to eligible entities to run programs that educate and train individuals to enter and advance in career pathways related to pregnancy, childbirth, or postpartum. The projects must be located in a State that recognizes doulas or midwives and that provides payment for their services through insurance. This creates a federal funding stream aimed at building a maternal-care workforce.
Project duration
Demonstration projects funded under this subsection must run for not less than three years. This duration is intended to support the development and evaluation of stable career pathways, including training, certification, and ongoing professional development for participants.
Application requirements
Applicants must submit an application detailing partnerships, staffing decisions, programmatic elements, and other design features intended to support a strong career pathway in pregnancy, childbirth, or postpartum services. The application must show that the State recognizes and permits doulas and midwives to practice and that the applicant has experience working with low-income populations, or a plan to partner with an entity that does.
Evaluations
The Secretary shall conduct rigorous evaluations of the funded demonstration projects, using grant-based, contract, or interagency mechanisms. Evaluations must identify successful activities for developing and sustaining pathways for low-income individuals through a doula, midwife, or related pregnancy-care workforce, with entry points, high education/training standards, wage growth, and affordable benefits, including health coverage.
Definitions and eligible entities
Defines eligible entities to include a broad array of organizations (local workforce boards under WIOA sec. 107, state and substate agencies, tribes, IHEs, hospitals, FQHCs, 501(c)(3) nonprofits, labor organizations, and other health-profession-training entities). It also sets out definitions for eligible individuals (income not exceeding 138% FPL), midwives (international standards), tribally-recognized midwives, and doulas (training, certification, and local government authorization where required).
Appropriation
Authorizes $10,000,000 from the Treasury for FY2026 to carry out this subsection, signaling a dedicated federal investment to build maternal-care career pathways.
Effective date
The amendment takes effect on October 1, 2025, aligning with the fiscal and program-launch timing set by the act.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Low-income individuals eligible for the HPOG program gain access to education and training in pregnancy, childbirth, or postpartum careers and may see improved wages and benefits.
- Doulas and midwives in states recognizing their services could access formal training, certification pathways, and expanded employment opportunities.
- Hospitals, birthing centers, and health systems may benefit from a growing, trained workforce specializing in maternal-care services.
- Local workforce boards and state workforce agencies gain a federally supported program to pilot and evaluate new career pathways and to partner with healthcare providers and training institutions.
Who Bears the Cost
- The federal government funds the program through FY2026 with a $10 million appropriation, representing the primary cost to taxpayers.
- State and local agencies must administer grants, oversee program implementation, and report results, creating ongoing administrative costs.
- Grantee organizations incur program design, staffing, and evaluation costs to implement and sustain the demonstration projects.
Key Issues
The Core Tension
The central dilemma is balancing flexible, broad grant-eligibility and rapid deployment of a new maternal-care workforce pathway with the need for consistent standards, state-level regulatory alignment for doulas/midwives, and durable funding that survives after the initial demonstration period.
The bill creates a significant new demonstration-project track that hinges on state recognition of doulas and midwives and on insurers covering these services. That linkage introduces potential state-by-state variation in who can participate and how services are paid for, which could affect program reach and consistency of outcomes.
While the bill requires rigorous evaluations, it does not specify performance metrics or long-term sustainability beyond the initial 3-year horizon, raising questions about scaling the model if results are favorable. The broad eligibility for entities is a strength for access but could complicate quality controls and coordination with existing WIOA-funded programs, state licensing, and professional standards.
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