About the Doula Medicaid 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 [email protected].

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“
Doula Report
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.
2020 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 [email protected].
BILL NUMBER | TITLE OF BILL | AUTHOR or PRIMARY SPONSOR | DESCRIPTION | STATUS | LAST DATE UPDATED |
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S.Res 479 | Designating January 23, 2020 As Maternal Awareness Day | Sen. Cory Booker | Designating January 23, 2020 As Maternal Awareness Day | Introduced | 1/27/20 |
H.Res 853 | Recognizing the maternal health crisis in the United States and the importance of reducing mortality and morbidity among all women, and honoring mothers. | McEachin | Introduced | 2/12/2020 | |
H.Res 826 | Expressing disapproval of the Trump administration's harmful actions towards Medicaid | Rep. Marc Veasey | Resolved, That it is the sense of the House of Representatives that- (1) the illegal actions taken by the Trump administration to undermine the Medicaid program, including beneficiary protections, are a cruel attack on a program that provides for the health and well-being for some of our most vulnerable citizens; (2) the Trump administration should immediately withdraw its illegal block grant guidance and cease its campaign to undermine and weaken Medicaid; and (3) the Trump administration should uphold its responsibility to faithfully execute the law, including the Medicaid Act, and cease any and all efforts that threaten the care of the millions of Americans who rely on Medicaid. | Motion to reconsider laid on the table Agreed to without objection | 2/06/2020 |
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 [email protected].
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 |
2020 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 [email protected].
STATE | BILL NUMBER | TITLE OF BILL | AUTHOR or PRIMARY SPONSOR | DESCRIPTION | STATUS | LAST DATE UPDATED |
---|---|---|---|---|---|---|
Maryland | SB 110 | Maryland Medical Assistance Program - Doulas | Arthur Ellis | First Reading Finance | 1/8/2020 | |
Virginia | SB 946 | State plan for medical assistance; doulas | Mamie Locke & Jennifer McClellan | Continued to 2021 in Finance and Appropriations (15-Y 0-N) | 2/4/2020 | |
Arizona | HB 2670 | Doulas; voluntary certification | Kelly Townsend | Senate Read Second Time | 3/3/2020 | |
Tennessee | HB 1847 | TennCare - As introduced, requires doula services to be provided to certain recipients of TennCare; requires the doula services be performed by a person who has received certain certification. | London Lamar | Taken off notice for cal in s/c TennCare Subcommittee of Insurance Committee | 3/11/2020 | |
Rhode Island | SB 2124 | AN ACT RELATING TO HUMAN SERVICES -- MEDICAL ASSISTANCE -- PERINATAL DOULA SERVICES (Provides for medical assistance health care for expectant mothers and establishes medical assistance coverage and reimbursement rates for perinatal doula services.) | Maryellen Goodwin | Placed on Senate Calendar | 3/11/2020 | |
Virginia | HB 29 | Budget Bill | Luke E Torian | Chapter 1283 (Final budget as adopted) | 4/28/2020 | |
Washington | SB 6168 | Budget Bill | Braun Rolfes | Governor partially vetoed. Chapter 357, 2020 Laws PV. Effective Date 4/03/2020 | 4/3/2020 | |
Illinois | HB 5226 | Medicaid-Maternal HLTH | Mary Flowers | Referred to Rules Committee | 2/18/2020 | |
California | AB 2258 | Doula care: Medi-Cal Pilot Program | Eloise Reyes | Referred to Committee on Health | 2/20/2020 | |
Minnesota | SB 3060 | Doulas listed on the registry of certified doulas certifying organization modification | Melisa Franzen | Referred to Health and Human Services Finanace Policy | 2/13/2020 | |
Minnesota | HB 3165 | Doula certifying organization list modified to be listed on certified doulas registry | Heather Edelson | Referred to Health and Human Services Policy | 2/11/2020 | |
Maryland | HB 1067 | Doulas - Technical Assistance Advisory Group and Certification | Jheanelle Wilkins | Hearing 3/06/2020 | 2/10/2020 | |
Maryland | SB 914 | Doulas - Doula Technical Assistance Advisory Group and Certification | Clarence Lam | Hearing 3/10/2020 | 2/7/2020 | |
Virginia | HB 687 | Doulas; certification registry | Lashrecse Aird | Governor Approved | 4/06/2020 | |
New Jersey | SB 1910 | Directs DOH to develop standardized perinatal health curriculum for community health workers. | Nilsa Cruz-Perez | Introduced & Referred to Senate Health, Human Services and Senior Citizens Committee | 2/24/2020 | |
Massachusetts | H 4448 | An Act to reduce racial disparities in maternal health | Kay Khan, Liz Miranda | New draft substituted, see H4818 | 6/29/2020 | |
Louisiana | HB 502 | Provides for health insurance coverage for maternity services provided by doulas | Matthew Willard | Read by title, under the rules, referred to the Committee on Insurance | 03/09/2020 | |
Connecticut | SB 395 | An Act concerning the establishment of the doula advisory council and doula certification | John Hampton | Human Services Public Hearing | 3/17/2020 | |
Virginia | HB 826 | State plan for medical assistance; payment for services provided by certified doulas. | Jennifer Carrol Foy | Approved by Governor | 4/7/2020 | |
New York | SB 7977 | Relates to the Chrisholm Chance Act; repealer | Zellnor Myrie | Referred to Health Committee | 3/6/2020 | |
Ohio | SB 328 | To Require Medicaid to Cover Doula Services | Tina Maharath | Refered to Committee on Health, Human Services, and Medicaid | 6/24/2020 | |
North Carolina | SB 732 | Create Medicaid Access to Doula Services | Senators Natalie Murdock; Joyce Waddel; Natasha Marcus | Referred to Committee on Rules and Operations of the Senate | 5/14/2020 | |
Michigan | 0965 | Human services; medical services; coverage for doula services; require | Erika Geiss | Referred to Committee on Health Policy and Human Services | 6/10/2020 | |
Massachusetts | H 1182 | An Act relative to Medicaid coverage for doula services. | Liz Miranda, Lindsay Sabadosa | Accompanied a new draft, see H4780 | 6/15/2020 | |
Massachusetts | H 4780 | An Act relative to Medicaid coverage for doula services. | Liz Miranda; Lindsay Sabadosa; Nika Elugardo, et al. | Bill reported favorably by committee and referred to the committee on House Ways and Means | 6/15/2020 |
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 [email protected].
STATE | BILL NUMBER | TITLE OF BILL | AUTHOR or PRIMARY SPONSOR | DESCRIPTION | STATUS | LAST DATE UPDATED |
---|---|---|---|---|---|---|
Arizona | HB2605 | Doulas; voluntary certification | Rep. Kelly Townsend | 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 | Favorable Report, Calendar #619 | 5/17/2019 | |
Illinois | HB 0004 | Medicaid-Doula Services | Rep. LaToya Greenwood | Re-referred to Rules Committee | 5/31/2019 | |
Illinois | SB 1909 | Health Pregnancy/Postpartum | Sen. Cristina Castro | 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. | Passed & Signed | 4/18/2019 | |
Massachusetts | H 1182 | An Act relative to Medicaid coverage for doula services. | Rep. Liz Miranda, Rep. Lindsay Sabadosa | 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. | 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. | 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. | Passed | 5/8/2019 | |
New York | A 04408 | Includes doulas as medical services providers for Medicaid recipients | Assemblywoman Michaelle C. Solages | Referred to Health & Same as SB S5656 | 2/4/2019 | |
New York | S 3344 | Relates to the professional certification of doulas | Sen. Jessica Ramos | 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 | 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. | Referred to House Finance | 6/28/2019 | |
Texas | HB 4301 | Relating to Medicaid coverage of doula services. | Rep. Armando Walle | 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 | 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 | 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. | 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. | Introduced | 6/25/2019 | |
Wisconsin | WI State Budget Item | Healthy Women, Healthy Babies State Budget Initiative | Tony Evers | 4/21/2019 |
National Health Law Program Resources
California
- Building A Successful Program for Medi-Cal Coverage For Doula Care: Findings From A Survey of Doulas in 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)
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)
Other Resources
- Creating Policy for Equitable Doula Access by HealthConnect One (October 2019)
- Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint by Center for American Progress (May 2019)
- Tackling Maternal Health Disparities: A Look at Four Local Organizations with Innovative Approaches by National Partnership for Women & Families (April 2019)
- Advancing Birth Justice: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities by Ancient Song Doula Services, Village Birth International, and Every Mother Counts (March 2019)
- Toolkit for Advancing the Human Right to Safe and Respectful Maternal Health Care by Black Mamas Matter Alliance (2018)
- Battling Over Birth Report by Black Women Birthing Justice (December 2017)
- Sustainable Funding for Doula Programs: A Study by HealthConnect One (June 2017)
- Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health by National Partnership for Women & Families, Childbirth Connection, and Choice in Childbirth (January 2016)