Doula Medicaid Project

About the Doula Medicaid Project

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The National Health Law Program’s Doula Medicaid Project seeks to improve health outcomes for pregnant Medicaid enrollees by ensuring that all pregnant individuals enrolled in Medicaid who want access to a doula, will have one.

Low-income women are at the highest risk of poor birth outcomes in the United States, and women of color, especially Black women, are especially vulnerable. Doula care is among the most promising approaches to combating disparities in maternal health. Women receiving doula care have been found to have improved health outcomes for both themselves and their infants, including higher breastfeeding initiation rates, fewer low-birth weight babies, and lower rates of cesarean sections. Doulas can also help reduce the impacts of racism and racial bias in health care on pregnant women of color by providing individually tailored, culturally appropriate, and patient centered care and advocacy.

We are lawyers, researchers, and policy advocates. We are not doulas. As such, we seek to do all our work in partnership with and with the guidance of community doula groups, doula collectives, and individual doulas, especially Black doulas and Black-led doula groups, as well as doulas and doula groups serving low-income clients.

To achieve the goal of Medicaid coverage of doula care, we are engaged in advocacy work on various fronts, including:

  • Working with doulas and other stakeholders to identify and overcome barriers to creating a sustainable and equitable Medicaid coverage of doula care program;
  • Educating legislators and other stakeholders about the importance of expanding full-spectrum Medicaid coverage of doula care, including doula support for prenatal care, labor/delivery, postpartum care, miscarriage management, and abortion;
  • Information gathering and sharing with states around the country who have proposed legislation relating to Medicaid coverage of doula care; and
  • Advocating for state legislation creating a Medicaid coverage of doula care program, initially in California and then promoted as a model strategy in other states.

If you have any questions or comments, would like more information, and/or would like to partner with us in this work, please contact NHeLP Senior Staff Attorney Amy Chen at chen@healthlaw.org.

2019 Federal Bills Relating to Medicaid Coverage for Doula Care

The National Health Law Program is currently tracking federal legislation relating to Medicaid coverage of doula care that has been introduced during the current legislative session. We have compiled our information into the chart below, which we hope will be a helpful resource for doulas, advocates, researchers, legislators, and other stakeholders working on this issue. We are doing our best to update this chart on a regular basis. If you have any corrections, comments, or questions about this chart, please contact NHeLP Policy Fellow Alexis Robles at robles@healthlaw.org.

BILL NUMBERTITLE OF BILLAUTHOR or PRIMARY SPONSORDESCRIPTIONSTATUSLAST DATE UPDATED
S 1343MOMMIES ActSen. Cory Booker• To amend titles XIX and XXI of the Social Security Act to improve Medicaid and the Children's Health Insurance Program for low-income mothers.
• Enhancing Medicaid and CHIP benefits for low-income pregnant women, including:
• Extending the 60-day period of coverage to 365-day period of coverage,
• Oral health coverage for pregnant and postpartum women,
• Enhanced FMAP,
• Reapplication of Medicare payment rate floor to primary care services furnished under Medicaid and inclusion of additional providers,
• MACPAC report and CMS guidance on Medicaid coverage for doula care, and GAO report on Medicaid programs' use of telemedicine to increase maternity care access.
Introduced5/7/2019
HR 2602Healthy MOMMIES ActRep. Ayanna Pressley• To amend titles XIX and XXI of the Social Security Act to improve Medicaid and the Children's Health Insurance Program for low-income mothers.
• Integrates perinatal support services including community health workers, doulas, social workers, public health nurses, peer lactation counselors, childbirth educators, and others, into health care entities and organizations.
• Provides financial incentives for health care professionals, including community health workers and community-based doulas who participate in the the State's maternity care home model.
• Provides adequate training for community health workers, doulas, and care coordinators who participate in the State's maternity care home model, which may include training for cultural competency, racial bias, health equity, reproductive and birth justice, home visiting skills, and respectful communication and listening skills, particularly in regards to maternal health.
Referred to House Committee on Energy and Commerce5/8/2019
HR 2751Mamas First ActRep. Gwen Moore• To amend title XIX of the Social Security Act to provide coverage under the Medicaid program for services provided by doulas and midwives, and for other purposes.
• Defines doula as certified by an organization (established for a minimum of 5 years), completing continuing education, who provides non-medical advice, information, emotional support, and physical comfort during such individual's pregnancy, childbirth, and postpartum period.
Referred to House Committee on Energy and Commerce5/15/2019
H.R. 3344Opportunities to Support Mothers and Deliver Children ActRep. Gwen Moore•To provide grants for the conduct of demonstration projects designed to provide education and training for eligible individuals to enter and follow a career pathway in the field of pregnancy or childbirth, under the health profession opportunity grant program under section 2008 of the Social Security Act.Referred to House Committee on Ways and Means6/19/2019
S 1600Maternal CARE ActSen. Kamala Harris• To support States in their work to end preventable morbidity and mortality in maternity care by using evidence-based quality improvement to protect the health of mothers during pregnancy, childbirth, and in the postpartum period and to reduce neonatal and infant mortality, to eliminate racial disparities in maternal health outcomes, and for other purposes.
• Implicit Bias training grants: Focused on providing training programs for health professionals on reducing implicit bias. Priority is given to obstetrics and gynecology.
• Pregnancy Medical Home Demonstration Project: Establishes a demonstration project to assist 10 states in implementing and sustaining a pregnancy medical home (PMH) program. This is to incentivize providers to deliver integrated health care services to pregnant and postpartum women. This includes doulas, other community health workers, and community organizations.
• National Academy of Medicine study and recommendations for incorporating bias recognition in clinical skills testing in U.S. medical schools.
Read twice and referred to the Committee on Health, Education, Labor, and Pensions5/22/2019
HR 4243Rural Maternal and Obstetric Modernization of Services ActRep. Xochitl Torres Small• To amend the Public Health Service Act to improve obstetric care in rural areas.
• Rural Obstetric Network Grants: establish a collaborative improvement and innovation networks to improve outcomes in birth and maternal morbidity and mortality with $3,000,000 for each of the fiscal years 2020 through 2024.
• Telehealth Network and Telehealth Resource Centers Grant Programs
• Rural Maternal and Obstetric Training Demonstration: establish training demonstration program to award grants to eligible entities to supporttraining for physicians, medical residents, including family medicine and obstetrics and gynecology residents, and fellows to practice maternal and obstetric medicine in rural community-based settings; training for licensed and accredited nurse practitioners, physician assistants, certified nurse midwives, certified midwives, certified professional midwives, home visiting nurses, or non-clinical professionals such as doulas and community health workers, to provide maternal care services in rural community-based settings; and establishing, maintaining, or improving academic units or programs that provide training for students or faculty, including through clinical experiences and research, to improve maternal care in rural areas; or develop evidence-based practices or recommendations for the design of the units or programs, including curriculum content standards.
• GAO Report: No later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the appropriate committees of Congress a report on the maternal, including prenatal, labor and birth, and postpartum care in rural areas
Referred to the House Committee on Energy and Commerce9/09/2019

2019 State Bills Relating To Medicaid Coverage of Doula Care

The National Health Law Program is currently tracking state legislation relating to Medicaid coverage of doula care that has been introduced during the current legislative session. We have compiled our information into the chart below, which we hope will be a helpful resource for doulas, advocates, researchers, legislators, and other stakeholders working on this issue. We are doing our best to update this chart on a regular basis. If you have any corrections, comments, or questions about this chart, please contact NHeLP Policy Fellow Alexis Robles at robles@healthlaw.org.

STATEBILL NUMBERTITLE OF BILLAUTHOR or PRIMARY SPONSORDESCRIPTIONSTATUSLAST DATE UPDATED
ArizonaHB2605Doulas; voluntary certificationRep. Kelly Townsend House Read 2nd Time2/13/2019
ConnecticutSB 1078An Act Concerning Doula Certification and Medicaid Reimbursement for Doula ServicesSen. Martin Looney, Sen. Robyn PorterFavorable Report, Calendar #6195/17/2019
IllinoisHB 0004Medicaid-Doula ServicesRep. LaToya Greenwood
Re-referred to Rules Committee5/31/2019
IllinoisSB 1909
Health Pregnancy/PostpartumSen. Cristina Castro Re-referred to Rules Committee6/28/2019
IndianaSB 416
Medicaid Coverage for doula services. Provides that Medicaid pregnancy services may include reimbursement for doula servicesSen. Jean Breaux, Sen. Ed Charboneneau, Sen. Jean Leising, et al.Passed & Signed4/18/2019
MassachusettsH 1182
An Act relative to Medicaid coverage for doula services.Rep. Liz Miranda, Rep. Lindsay SabadosaHearing scheduled for 09/10/2019 from 01:00 PM-05:00 PM in B-18/28/2019
New JerseyAB 4932
Establishes perinatal episode of care pilot program in MedicaidRep. Gabriela Mosquera, Rep. Adam Taliaferro, Rep. Daniel Benson, et al.Substituted by SB 33653/25/2019
New JerseySB 3365
Establishes perinatal episode of care pilot program in MedicaidSen. Nellie Pou, Sen. Joseph Cryan, Rep. Gabriella Mosquera, et al. Passed 5/8/2019
New JerseySB 1784
Provides Medicaid Coverage for Doula CareSen. Loretta Weinberg, Sen. Nia Gill, Rep. Eliana Marin, et al.Passed 5/8/2019
New YorkA 04408
Includes doulas as medical services providers for Medicaid recipientsAssemblywoman Michaelle C. Solages Referred to Health & Same as SB S56562/4/2019
New YorkS 3344
Relates to the professional certification of doulasSen. Jessica RamosReturned to Assembly Passed Senate 3rd Reading
CAL.243 Substituted for S 3344B
6/18/2019
New YorkSB S5656Includes doulas as medical services providers for Medicaid recipientsSen. Roxanne Persaud
In Senate Committee5/10/2019
Rhode IslandSB 678

Medical Assistance: Perinatal Doula ServicesSen. Ana Quezada, Sen. Bridget Valverde, Sen. Melissa Murray, et al.Referred to House Finance6/28/2019
TexasHB 4301

Relating to Medicaid coverage of doula services.Rep. Armando WalleReferred to Human Services3/25/2019
VermontH 219
An act relating to Medicaid coverage for doula servicesRep. Diana Gonzalez
Rep. Barbara Rachelson
Referred to the Committee on Health Care2/13/2019
WashingtonEngrossed Substitute HB 1109
WA State Health Care Authority Budget
Code Title: Doula Services
Program Title: Maternity Support Services Program
Jim SmithPassed5/21/2019
Washington D.C.B23-0341Perinatal Health Worker Training Access Act of 2019CNC. Robert White, Mary Cheh, Anita Bonds, et al.Notice of Intent to Act on B23-0341 Published in the D.C. Register6/21/2019
Washington D.C.B23-0632Maternal Health Care Improvement and Expansion Act of 2019CNC. Charles Allen et al.Introduced6/25/2019
WisconsinWI State Budget ItemHealthy Women, Healthy Babies State Budget Initiative Tony Evers4/21/2019

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