Doula Medicaid Project

About the Doula Medicaid Project

The National Health Law Program (NHeLP)’s Doula Medicaid Project seeks to improve health outcomes and address inequities in maternal health by ensuring that all pregnant, postpartum, and post-pregnancy people who want access to a doula can have one. Our starting point in this work is expanding access to sustainable, equitable, and inclusive programs for Medicaid coverage for doula care.

People with low incomes in the United States are at a higher risk of poor birth outcomes, and pregnant and birthing people of color, especially Black and Indigenous/Native American pregnant and birthing people, are especially vulnerable. Doula care is one promising approach to combating inequities in maternal health. Pregnant and birthing people receiving doula care are more likely to have improved health outcomes for both themselves and their infants, including fewer low birth weight babies, lower rates of cesarean births, and higher breastfeeding initiation rates. 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 client-centered care and advocacy.

NHeLP supports and advocates for full spectrum doula care, which we define as doula care for all the ways in which a pregnancy can end, including doula care for prenatal, labor/delivery, and the postpartum period, as well as doula care for abortion, miscarriage, and stillbirth.

To achieve the goal of universal 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 propose policies, pass legislation, and implement programs for Medicaid and private insurance coverage for doula care in their states and regions;
• Educating agencies, legislators, and other stakeholders about the importance of expanding coverage of full spectrum doula care;
• Lifting up best practices from our advocacy work to achieve sustainable, equitable, and inclusive programs for Medicaid and private insurance coverage of doula care;
• Creating and publishing resources including fact sheets, reports, issue briefs, and other materials relevant to expanding access to doula care; and
• Maintaining multiple listservs to share state and regional updates, resources, events, and other topics relevant to expanding access to doula care.

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-based 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.

Note on language:  The word “doula” comes from the ancient Greek word for “female servant” or “female slave.” Over time, the term evolved to its modern meaning of a trained professional who provides non-clinical physical, emotional, and informational support during the perinatal period. Doula work has also expanded to include the full spectrum of pregnancy outcomes (e.g., birth, abortion, adoption, miscarriage, stillbirth, and perinatal loss), as well as services to women, men, transgender, and gender non-conforming people. After consideration, NHeLP will continue to use the terms “doula” and “full spectrum doula” in our Doula Medicaid Project work, while also noting alternative terms (e.g., birthworkers, full spectrum support advocates, etc.) in parentheses. Read our issue brief, NHeLP’s Framing and Language in the Doula Medicaid Project, to learn about our process for arriving at this decision.

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