Doula Medicaid Project

About the Doula Medicaid Project

Learn more about this artwork created by Megan Smith and watch a short video about the evolution of the design at Youtube.com/watch and explore their “Repeal Hyde Art Project“

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 NUMBER	TITLE OF BILL	AUTHOR or PRIMARY SPONSOR	DESCRIPTION	STATUS	LAST DATE UPDATED
S 1343	MOMMIES Act	Sen. 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.	Introduced	5/7/2019
HR 2602	Healthy MOMMIES Act	Rep. 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 Commerce	5/8/2019
HR 2751	Mamas First Act	Rep. 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 Commerce	5/15/2019
H.R. 3344	Opportunities to Support Mothers and Deliver Children Act	Rep. 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 Means	6/19/2019
S 1600	Maternal CARE Act	Sen. 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 Pensions	5/22/2019
HR 4243	Rural Maternal and Obstetric Modernization of Services Act	Rep. 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 Commerce	9/09/2019

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.

STATE	BILL NUMBER	TITLE OF BILL	AUTHOR or PRIMARY SPONSOR	DESCRIPTION	STATUS	LAST DATE UPDATED
Arizona	HB2605	Doulas; voluntary certification	Rep. Kelly Townsend	Show description... • Defines “Certified community doulas” as those that were given certification by the Department of Health Services in Arizona • Defines ""doula"" as a trained nonmedical health worker who provides continous physical, emotional, and informational support to a mother before, during, and after childbirth and who serves as a liaison between the birthing parent and medical and social services staff to improve the quality of medical, social, and behavioral outcomes. • Director of the Department of Health Services must identify criteria necessary to become a certified doula and has the power to revoke a certificate, director will define minimum qualifications for training and education. • Core competencies include skills and areas of knowledge to bring expanded health access and wellness in diverse communities and to reduce health disparities. • Details the application process for becoming certified which includes an application fee and renewal every two years • Establish minimum education, training, experience, and other qualifications for trainers. • Clarifies that certificates are not necessary to practice as a community doula in the state	House Read 2nd Time	2/13/2019
Connecticut	SB 1078	An Act Concerning Doula Certification and Medicaid Reimbursement for Doula Services	Sen. Martin Looney, Sen. Robyn Porter	Show description... • Outlines steps and requirements to becoming a certified state doula. • Requirements for reimbursement through Medicaid: have a national provider id number, complete all required Medicaid Provider Enrollment forms, provide copy of state doula certification to commissioner, perform Medicaid-eligible services. • Doulas shall be billed on a fee-for-service basis, per pregnancy for Medicaid eligible services. Reimbursement shall not be less than $900 and not exceed $1500. • Medicaid eligible services include: prenatal visits, physical and emotional support, telephone or virtual communications between certified doula and Medicaid beneficiary, time spent being on call for birth, time spent providing a Medicaid beneficiary services and support during birth, postpartum visits, time spent on administrative tasks, such as documentation or paperwork, among others.	Favorable Report, Calendar #619	5/17/2019
Illinois	HB 0004	Medicaid-Doula Services	Rep. LaToya Greenwood	Show description... • Provides doula coverage under medical assistance program. • Sets forth certain certification and training requirements for doulas in order to be reimbursed. • To be eligible for reimbursement doulas must be certified by an organization that is nationally recognized for training and certification of doulas, complete a cultural competency course, complete a course on HIPAA compliance, be certified to provide cardiopulmonary resuscitation, and submit to a federal and state background check.	Re-referred to Rules Committee	5/31/2019
Illinois	SB 1909	Health Pregnancy/Postpartum	Sen. Cristina Castro	Show description... • Requires certain group health insurance policies to provide coverage of medically necessary treatment for postpartum complications • Extends medical assistance coverage to one year postpartum • Provides coverage for doula care, perinatal depression screenings • Requires DCFS to seek SPA to expand family planning coverage to women at/below 200% FPL • Removes rebuttable presumption of parent's unfitness based on presence of controlled substance at birth	Re-referred to Rules Committee	6/28/2019
Indiana	SB 416	Medicaid Coverage for doula services. Provides that Medicaid pregnancy services may include reimbursement for doula services	Sen. Jean Breaux, Sen. Ed Charboneneau, Sen. Jean Leising, et al.	Show description... • Medicaid coverage of doula care. • May apply for a SPA or waiver to implement	Passed & Signed	4/18/2019
Massachusetts	H 1182	An Act relative to Medicaid coverage for doula services.	Rep. Liz Miranda, Rep. Lindsay Sabadosa	Show description... • Defines doula as a trained professional who provides physical, emotional, and educational support, but not medical care to mother before, during, and after childbirth. Doulas coverage eligibility through private insurance and MassHealth. • Lays out standards for doula certification and training, establishes a statewide registry of doulas, sets up payment ($1500 inclusive), • To be covered doulas must: apply for a National Provider ID Number, have a training certificate through a certified organization (examples provided), and have at least 24 contact hours of in-person education that include any combination of childbirth education, birth doula training, antepartum doula training, and postpartum. • Once enrolled as a MassHealth provider, a doula will be eligible to enroll as a provider with Fee-for-Service, Managed Care, and Accountable Care Payers, affiliated with MassHealth.	Hearing scheduled for 09/10/2019 from 01:00 PM-05:00 PM in B-1	8/28/2019
New Jersey	AB 4932	Establishes perinatal episode of care pilot program in Medicaid	Rep. Gabriela Mosquera, Rep. Adam Taliaferro, Rep. Daniel Benson, et al.	Show description... • Establish a learning network to develop parameters for a 3 year perinatal episode care pilot program in Medicaid to improve outcomes and reduce cost. • Identifies communities doulas as a wraparound patient support service and to be potentially covered.	Substituted by SB 3365	3/25/2019
New Jersey	SB 3365	Establishes perinatal episode of care pilot program in Medicaid	Sen. Nellie Pou, Sen. Joseph Cryan, Rep. Gabriella Mosquera, et al.	Show description... • Establish a learning network to develop parameters for a 3 year perinatal episode care pilot program in Medicaid to improve outcomes and reduce cost. • Identifies communities doulas as a wraparound patient support service and to be potentially covered.	Passed	5/8/2019
New Jersey	SB 1784	Provides Medicaid Coverage for Doula Care	Sen. Loretta Weinberg, Sen. Nia Gill, Rep. Eliana Marin, et al.	Show description... Medicaid coverage of doula care (Replaced AB 1662) From the bill summary: This bill provides for the expansion of the State Medicaid program to include coverage for doula care. A doula is a trained professional who provides physical, emotional, and educational support, but not medical care, to mothers before, during, and after childbirth.	Passed	5/8/2019
New York	A 04408	Includes doulas as medical services providers for Medicaid recipients	Assemblywoman Michaelle C. Solages	Show description... • Includes doulas as a type of medical service provider available for Medicaid recipients • Requires commissioner of health to apply for waivers or amendments for Medicaid coverage of doulas	Referred to Health & Same as SB S5656	2/4/2019
New York	S 3344	Relates to the professional certification of doulas	Sen. Jessica Ramos	Show description... • Amends the public health law to require doulas to be certified, over 18 years of age, and of good moral character to be called “certified doulas” • Defines doula services as continous emotional and physical support throughout labor and birth, and intermittently during the prenatal and postpartum period. • Outlines process for doula certification which includes 3 major steps: filing an application within the department, satisfying department’s education requirements, and passing an examination • Requires payment of at least $40 for a license and $10 for a limited permit • Does not intend to create an exclusive scope of practice but instead the title of "certified doula"	Returned to Assembly Passed Senate 3rd Reading CAL.243 Substituted for S 3344B	6/18/2019
New York	SB S5656	Includes doulas as medical services providers for Medicaid recipients	Sen. Roxanne Persaud	Show description... • Includes doulas as medical services providers for Medicaid recipients; directs the commissioner of health to submit an application for amendments and waivers to add doulas to such coverage pursuant to section 363-e of the social services law; and directs the commissioner of health and the commissioner of children and family services to add, amend and/or repeal any rule or regulation necessary.	In Senate Committee	5/10/2019
Rhode Island	SB 678	Medical Assistance: Perinatal Doula Services	Sen. Ana Quezada, Sen. Bridget Valverde, Sen. Melissa Murray, et al.	Show description... • Medicaid coverage of doula care • Outlines steps for doulas to be reimbursable by Medicaid. Including getting a provider ID number, provided a certificate from a doula organization, and letter detailing their completion in core competencies, including at least 24 contact hours. • Creates a state registry of qualified doulas • Doula services do not include: "practice of medicine" • Doulas may be reimbursed through Fee-For-Service and up to one year postpartum and not to exceed $1,500 • To take effect 7-1-2020	Referred to House Finance	6/28/2019
Texas	HB 4301	Relating to Medicaid coverage of doula services.	Rep. Armando Walle	Show description... • Requires Commission to implement Medicaid coverage of doula care and make determination w/r/t services covered and certification, effective Sep 1, 2019 • Doula services for childbrith education, emotional and physical support during pregnancy, labor, birth, and postpartum	Referred to Human Services	3/25/2019
Vermont	H 219	An act relating to Medicaid coverage for doula services	Rep. Diana Gonzalez Rep. Barbara Rachelson	Show description... • Qualified doulas shall be reimbursed for providing childbirth education and support services, including physical and emotional support, to individuals covered by Medicaid during pregnancy, labor and delivery, and postpartum. The Department shall keep a registery of qualified doulas. Doulas will not be reimbursed for travel time or mileage. • Describes requirements for obtaining Medicaid reimbursement such as receiving additional training designed specifically for serving marginalized populations, having certification from a national approved organization, and having personal liability insurance. Organizations that doulas may received certification at their own cost include: Birthworks, Childbirth International, CAPPA, Commonsense Childbirth Inc., DONA, ICTC, International Childbirth Education Association. • Restricts reimbursement to no more than $750 • Establishes reimbursement rates - $25 for prenatal visits per hour for up to 4 hours, $550 for support during delivery, $25 per hour for postpartum visits for up to 2 hours, and up to $50 for administrative expenses	Referred to the Committee on Health Care	2/13/2019
Washington	Engrossed Substitute HB 1109 WA State Health Care Authority Budget	Code Title: Doula Services Program Title: Maternity Support Services Program	Jim Smith	Show description... • Proposal to fund doula services under the Maternity Support Services (MSS) program. • MSS to be expanded to provide 2 antepartum visits, two postpartum visits, labor support for MSS clients by CHW/R's certified as doulas by a national or state professional organization. Assumes reduced costs for health care delivery system and health disparities through doula coverage	Passed	5/21/2019
Washington D.C.	B23-0341	Perinatal Health Worker Training Access Act of 2019	CNC. Robert White, Mary Cheh, Anita Bonds, et al.	Show description... • Within 120 days of the effective date, the Department of Health wil disburse grant funds annually to implement a perinatal health worker training program that trains individuals in Wards 5, 7, 8 to provide culturally congruent nonclinical care to individuals during their perinatal period, including didactic training on reproductive health, including physical, mental, and social wellbeing related to the functioning of the reproductive system.	Notice of Intent to Act on B23-0341 Published in the D.C. Register	6/21/2019
Washington D.C.	B23-0632	Maternal Health Care Improvement and Expansion Act of 2019	CNC. Charles Allen et al.	Show description... • To require individual or group health plans and health insurance coverage through Medicaid or the D.C. Healthcare Alliance program to cover at least two postpartum healthcare visits, home visits, fertility preservation services, and transportation stipends for travel to and from prenatal and postpartum visits, to require Medicaid to provide coverage for pregnant District residents with an income at 319% of the federal poverty level for one year postpartum, to require the Department of Health to conduct a study on the feasibility of developing a curriculum to train doulas, to establish a Center on Maternal Health and Wellness; and to require implicit bias training to be included in continuing medical education coverage	Introduced	6/25/2019
Wisconsin	WI State Budget Item	Healthy Women, Healthy Babies State Budget Initiative	Tony Evers	Show description... • Governor Evers’ budget proposal includes a total of $618,700 over the biennium to make doula services reimbursable through Medicaid and fund doula training programs. Governor Evers’ budget would require DHS to request any necessary federal approval to allow Medicaid reimbursement for doulas. This budget earmarks $234,700 (in fiscal year 2020-21) for a pilot program to provide Medicaid reimbursement for doula services for eligible individuals who live in Milwaukee, Rock, Dane, Brown and Sheboygan counties and use a certified doula. The Department of Health Services (DHS) would administer certifications. This budget allocates $192,000 per year in training grants for doulas. These grants will be awarded to organizations that provide community-based doula services to identify and train local community workers to mentor pregnant women.		4/21/2019

National Health Law Program Resources

California

One pager on our advocacy campaign, Supporting Mothers and Saving Lives: Creating a Medi-Cal Coverage Program for Doula Care in California (April 2019)
In February 2019, we completed a survey of doulas in California about their practice and their thoughts on Medicaid coverage for doula care; will be publishing results of the survey in early 2019

National

Issue Brief A Guide to Proposed and Enacted Legislation for Medicaid Coverage for Doula Care (August 2019)
Blog post Women are Dying in Childbirth: Doulas are Part of the Solution (August 2019)
Blog post Legislative Proposals Addressing Maternal Mortality (August 2019)
Guest interview for Good Birth For All Podcast about Medicaid coverage of doula care (February 2019)
Fact sheet 2017-2018 Federal Legislative Proposals Relating to Maternal and Infant Health and Mortality (January 2019)
Blog post The Doula Difference: State and Federal Bills Aim at Reducing Maternal Health Disparities through Doula Services (March 2019)
Fact sheet State and Federal Legislative Proposals Relating to Doula Care (February 2019)
Issue brief Routes to Success for Medicaid Coverage of Doula Care co-published with the California Preterm Birth Initiative (December 2018)