Doula Medicaid Project

About the Doula Medicaid Project

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

Low-income people in the United States are at a higher risk of poor birth outcomes, and pregnant and birthing people of color, especially Black pregnant and birthing people, are especially vulnerable. Doula care is among the most promising approaches to combating disparities in maternal health. Pregnant and birthing people 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 births. Doulas can also help reduce the impacts of racism and racial bias in health care on pregnant people of color by providing individually tailored, culturally appropriate, and patient-centered care and advocacy.

At NHeLP, 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 full spectrum doula care, we are engaged in advocacy work on various fronts, including:

  • Working with doulas and other stakeholders across the country to provide technical assistance, information sharing, and other support as they work to propose policies, pass legislation, and implement programs for Medicaid coverage for doula care in their states and regions;
  • Educating state agencies, legislators, and other stakeholders about the importance of expanding full-spectrum Medicaid coverage of doula care, including doula support during the prenatal and postpartum periods, labor/delivery, miscarriage, stillbirth, and abortion;
  • Identifying and overcoming barriers to creating sustainable, equitable, and inclusive programs for Medicaid coverage for doula care;
  • 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, or would like more information, please contact NHeLP Senior Attorney Amy Chen at [email protected].

Illustrator M Jay Smith created the lovely artwork which is the centering image for the Doula Medicaid Project. Watch a short time-lapse video of the creation of the design and read Smith’s artist statement here.

Current State Doula Medicaid Efforts

The National Health Law Program’s Doula Medicaid Project is tracking current state doula Medicaid efforts, including states that have enacted legislation and are in the process of implementing Medicaid coverage for doula care. 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 Health Policy Analyst Alexis Robles-Fradet at [email protected].
We would like to express our gratitude to all the doulas and advocates we spoke with in compiling this chart, including Lizet Ansaldo, Ebonie Bailey, Andrea Berry, Ashley Black, Jasmyne Bryant, Gerria Coffee, Yuki Davis, Twylla Dillion, Amanda Dodson, Rebecca Elliott, Ashley Ezzio, Sara Finger, Ireta Gasner, Christina Gebel, Erika Geiss, Tony Gillespie, Kayla Goldfarb, Molly Gosselink, Karla Gutierrez, Ashley Hill Hamilton, Linda Herrick, Danita Jackson, Marcus Johnson-Miller, Thunwa Klaihathai, Enjolie Lafaurie, Samantha Lew, Kyesha Lindberg, Katharine London, Michelle Ludwig, Raquel Mazon Jeffers, Wendy McWeeny, Brian Merlos, Fatima Modaba, Ashley Nguyen, Raeben Nolan, Maria Noyes, Quatia Osorio, Breechelle Parker, Chanel Porchia-Albert, Laura Register, Jessica Roach, Anjali Salvador, Quentin Savwoir, Elizabeth Simmons, Nan Strauss, Kenda Sutton-El, Kate Symmonds, Sarah Teel, Kara Van de Grift, Jackie Vaughn, Kelly Vyzral, Steven Wagner, Jazmin Williams, Sunny Lu Williams, Dorian Wingard, and Elizabeth Wood.
This chart was compiled by Sarah Hart, NHeLP 2021-2022 intern and Georgetown law student.
KEY TO CURRENT STATUS COLORS
Green = Actively reimbursing doula services on Medicaid plans
Yellow = In the process of implementing Medicaid doula benefits
Blue = Action taken that is adjacent to Medicaid doula benefits (e.g., pilot program, doula registry)
Purple = Action proposed but no progress

Archive of State and Federal Legislation

The Doula Medicaid Project tracked state and federal legislative efforts related to expanding access to doula care in 2019, 2020, and 2021. We have archived our bill tracking charts, and they are available for download in PDF form below. If you have any questions about these charts, please contact NHeLP Health Policy Analyst Alexis Robles-Fradet at [email protected].

 

State Legislation Related to Expanding Doula Access

Federal Legislation Related to Expanding Doula Access

California Doula Pilots Lessons Learned Project

From October to November 2021, the National Health Law Program’s Doula Medicaid Project conducted interviews with doulas, funders, and/or administrative staff involved with at least ten doula pilot programs in California with a primary focus on addressing racial health disparities, and in particular on providing free doula services to either Black pregnant and birthing people or Medicaid enrollees. Overall, we found that the programs share remarkable consistency across some broader themes. At the same time, on a more granular level, the doula pilots have been quite distinct from one another, with different funding structures, scope of care provided, recruitment plans, training requirements, etc. On January 26, 2022, the Doula Medicaid Project held a panel discussion with representatives from six of the interviewed doula pilot programs.

What follows are a set of publications and resources that we have created from our interviews, conversations, and panel discussion. We hope that in compiling and sharing out this information, the experience and expertise of those involved in these doula pilots can help to inform the rollout and implementation of California’s statewide doula Medicaid benefit. We also hope that this information can be helpful for doulas and advocates in other states across the country who are setting up similar doula pilot programs or expansions of doula care in their own regions.

Building A Successful Program for Medi-Cal Coverage For Doula Care: Findings From A Survey of Doulas in California

The Doula Medicaid Project is proud to publish our report Building A Successful Program for Medi-Cal Coverage For Doula Care: Findings From A Survey of Doulas in California. The report is the distillation of a survey of doulas across California, as well as a series of focus groups held at four locations across the state. We hope that this report provides doulas, advocates, agencies, and other stakeholders with the information and insight needed to expand access to doula care in an equitable, inclusive, and sustainable way, both in California and across the nation.

We have also published an assortment of one-page fact sheets intended to introduce advocates, agencies, and other stakeholders to the important work of doulas.

National Health Law Program Resources

California

National

Other Resources