Written by pro bono partner, with supervision from Amy Chen
Medicaid coverage for doula care is a recent development, with much of the activity in state implementation having taken place in the last three to five years. Currently, 28 states, Guam, and Washington D.C. have implemented Medicaid coverage for doula care. Although more than half of states now offer coverage, publicly available data regarding coverage and accessibility remains inconsistent. This is due to several factors, including how recently the state began coverage, the complexity of bureaucratic processes, and dependence on third parties to provide the data. Unsurprisingly, states that began coverage for doula care within the last year have little to no available data.
We surveyed publicly available information for each of the states that have implemented Medicaid coverage for doula care, looking for the number of doulas enrolled as Medicaid providers in each state. For each state offering doula services, we identified the total number of doulas who have obtained National Provider Identifier (NPI) numbers. We then compared it to the number of doulas successfully enrolled as Medicaid providers. We identified these doulas by searching through doula directories and provider searches of each state’s managed care organization websites. We found comprehensive doula enrollment data for ten states, and limited enrollment data for fifteen others. Through examination of the enrollment data, we can piece together a broader picture of the current state of doula Medicaid coverage.
Of the states with comprehensive data, the two with the highest numbers of Medicaid enrolled doulas are California with 2,042 and Michigan with 906.[1] These two states also have the highest percentages of doulas who have obtained NPI numbers who have subsequently been able to successfully enroll as Medicaid providers (CA – 88%; MI – 56%).[2] While doulas and doula groups in California continue to face challenges, particularly with the Medicaid managed care organizations, they have also long collaborated with and maintained an open line of communication with their State Medicaid Agency through various stakeholder workgroups and other methods. This is likely a key reason for its higher successful enrollment numbers. In Michigan, funding was allocated in the state budget to create the Michigan Doula Initiative, a state public health entity with the goal of expanding the doula workforce and promoting access to doula care in the state, including supporting organizations to offer training, mentorship, and professional development for doulas in Michigan. Michigan based foundations have also made funding available for awareness campaigns on Medicaid coverage of doula services. These intentional and state-based efforts have also likely contributed to more successful enrollment in the state.
States structure their Medicaid programs differently. Some utilize a large network of Managed Care Organizations (“MCOs”) to administer coverage, while others operate Medicaid Fee-for-Service systems without any Medicaid MCOs. For example, Michigan and California both have more than eight different traditional MCOs, whereas Connecticut and South Dakota administer coverage through traditional Fee-for-Service models. However, the structure of a state’s Medicaid program does not appear to have a significant impact on the availability of coverage for doula care. That is, states with the most expansive MCO structures do not necessarily have either the most or least doulas enrolled. Of the states with the five highest percentages of doulas who obtained NPI numbers who have been able to successfully enroll as Medicaid providers (CA – 88%, MI – 56%, RI – 50%, MA – 48%, SD – 32%), California and Michigan have more than eight Medicaid MCOs, while Rhode Island, Massachusetts, and South Dakota have fewer than three each. These findings suggest that states seeking to implement Medicaid coverage for doula care can do so successfully regardless of how their Medicaid programs are structured.
Notably, in every state there is a substantial gap between the number of doulas enrolled as providers and the number of Medicaid enrollees who are potentially eligible for their services. The gap is evident when comparing doula enrollment data to the annual numbers of births in each state financed by Medicaid. For example, the earliest implementing state with robust implementation data is New Jersey, which began offering doula benefits in 2021. New Jersey currently has 254 enrolled doulas. Roughly 30,000 births annually in New Jersey are financed by Medicaid.[3] Contrasting 30,000 annual births against the 254 doulas enrolled as Medicaid providers makes the severe lack of accessibility clear. Improving access to doula care could have a substantial positive impact for pregnant, postpartum, and post-pregnancy individuals across the country, given that roughly 40% of all births are financed by Medicaid. It is clear that the pool of doulas enrolled as Medicaid providers is still far too small to meet the needs of the Medicaid-covered population, speaking to the need for a more substantial ramp-up in training the next generation of Medicaid doula providers in each of these states.
Generally speaking, the longer a state has implemented Medicaid coverage for doula care, the more doulas have enrolled. At present, many states are still in the early stages of implementation, and their enrollment numbers are not stagnant. We can expect the doula enrollment numbers to continue to rise as there is growing awareness and outreach about the benefit, and as more doulas in implementing states successfully enter and complete doula training and certification programs. The data we were able to obtain does show significant growth in access since the implementation of Medicaid coverage. For example, the number of doula-related claims in Ohio saw a large increase over the course of 2025, from 11 claims in January to 116 claims in November. The data also demonstrates that people will utilize doula care when it is made available. With continued progress along this trajectory, many states will be better positioned to close the gap and ensure access to doula care for all who need it.
Overall, our findings suggest that the structure of state Medicaid programs is less important than the length of time the state has offered doula care through Medicaid. Doula utilization statistics, particularly the number of doulas enrolled as Medicaid providers, are still far too low, but there is steady growth indicating meaningful progress. States with established Medicaid doula care coverage should collaborate with doulas and doula groups in the state and find ways to grow and support the doula workforce. This will leave them well positioned to continue expanding accessibility and to serve as models for newer states seeking guidance in expanding access to doula care.
[1] Note that in most states, doulas can enroll and bill as individuals or as groups, so the number of individual doulas providing services to Medicaid enrollees is likely higher than these numbers reflect.
[2] Not all providers who obtain NPI numbers go on to enroll as Medicaid providers. Some may still be in process or may have decided not to proceed with the Medicaid provider enrollment at this time. Others may have chosen to obtain an NPI number for other purposes.
[3] We can also compare figures for the two states mentioned earlier with the highest numbers of doulas enrolled. California, with 2,042 doulas enrolled, has roughly 162,000 births financed by Medicaid each year. Michigan, with 906 doulas enrolled, has roughly 36,000 births financed by Medicaid each year.
