State Strategies for Medicaid Coverage of Doula Services

Full Description: The United States faces a steadily increasing rate of maternal mortality with significant racial, ethnic, and socioeconomic disparities in birth outcomes. For centuries, Black, Indigenous, and People of Color (BIPOC) have had some form of community birth workers supporting pregnant people before, during, and after pregnancy. These individuals sometimes were identified in the Black community as “granny-midwives” or had a role that today would have been considered a “doula.” Doulas, who provide continuous physical, emotional, and informational support to people before, during, and shortly after childbirth, provide a way to address some maternal health inequities and generate potential savings over time to state Medicaid programs. Reflecting on a history of resiliency and community-driven support, states can increase access to doula services to improve birth outcomes for pregnant people of color and the overall trajectory of maternity care in the United States.

Research confirms that pregnant people who receive doula care are more likely to experience healthy birth outcomes, including lower preterm birth and caesarean section rates, higher five-minute Apgar scores for newborns (a test of five measures to evaluate an infant’s health), and a more positive self-reported birth experience. One study found that people who gave birth with a doula present were four-times less likely to have a low-birth-weight baby, two-times less likely to experience birth complications, and significantly more likely to initiate breastfeeding.

Recognizing that doulas could help decrease maternal mortality and improve birth outcomes for pregnant people and infants covered by Medicaid, many states are considering paying for doula services. At least seventeen states have introduced legislation to cover doula services in their Medicaid programs, and doula services are included in the Black Maternal Health Momnibus, a package of federal legislation to improve maternal health outcomes. Currently four states, Minnesota, New Jersey, Virginia, and Oregon, have approval from the Centers for Medicare & Medicaid Services (CMS) and provide doulas services as a Medicaid benefit to pregnant beneficiaries. This poster will highlight the approaches of each state including federal authority used, reimbursement structure, training requirements for doulas, cross-agency collaboration, and state strategies specifically focused on addressing racial equity. The poster will also highlight lessons learned from the different approaches of each state as well as key considerations for other state officials and stakeholders considering pursuing Medicaid coverage of doula services in their state.