Doula care is increasingly being recognized as a vital resource for pregnant and birthing people, with several states now covering doula care under their Medicaid programs. Yet coverage for doula care in private health insurance plans remains nearly nonexistent. A growing number of lawmakers and advocates are now looking to expand doula coverage in private plans.
Doulas offer culturally congruent care and provide emotional, physical, and informational support during the prenatal period, labor and delivery, and postpartum period. This support translates to meaningful improvements in maternal health; numerous studies have shown that doula care improves health outcomes and reduces racial disparities. To realize the full benefits associated with doula care, advocates and lawmakers must push for doula care to covered by both public and private plans.
Only one state currently requires private health insurance plans to cover doula care.
In 2021, Rhode Island became the first state to pass legislation requiring doula coverage in private insurance plans. The law applies to all fully insured commercial plans offered by a Rhode Island licensed insurer and issued after July 1, 2022. This means individuals are now guaranteed doula coverage if they purchase a plan through the Rhode Island health insurance exchange or receive coverage through a Rhode Island employer with less than fifty employees (excluding self-insured plans).
The law permits each plan to define their coverage “in accordance with each health insurers’ respective principles and mechanisms of reimbursement, credentialing, and contracting.” For Blue Cross Blue Shield of Rhode Island plans, members can be reimbursed for doula care up to $1,500. Services may include labor and delivery, as well as six total prenatal and postnatal visits.
Although private insurance coverage for doula care in Rhode Island is in its early days, the measure is expected to expand access to doula care, improve labor and delivery outcomes, and decrease costs.
Several states are considering expanding private coverage of doula care.
Lawmakers in several states are looking to follow Rhode Island’s example through either requiring or encouraging private plans to cover doula care.
- California law currently encourages health care service plans and insurers to cover doula care. In February 2023, lawmakers introduced a bill that would require insurers to develop a “maternal and infant health equity program” that would address racial disparities “through the use of doulas.”
- Indiana lawmakers introduced a bill in 2021 that would have required state employee health plans, policies of accident and sickness insurance, and health maintenance organization contracts to provide coverage for doula care. The bill failed to pass.
- Massachusetts lawmakers are considering a bill, introduced in January 2023, that would require all private health insurance plans to cover doula services.
- Missouri lawmakers are considering two bills relating to private coverage of doula care. The first, introduced in January 2023, would create a doula registry to allow for health insurance reimbursement of doula care. The second, introduced in February 2023, would require all health benefit plans and health carriers to provide coverage for doula care.
- New York lawmakers are considering a bill that would require health insurance policies to include coverage for doula services.
- Virginia lawmakers introduced a bill in January 2023 that would have required all private health plans that cover obstetrical services to provide coverage for doula care services. Plans would be required to cover at least eight prenatal and postnatal visits, as well as support during labor and delivery. In late January, lawmakers struck down the bills in both chambers and instead requested a study by the Senate Health Insurance Reform Commission. The Commission will hold public hearings on the proposal, and the State Corporation Commission and the Virginia Bureau of Insurance will do a preliminary analysis of its costs and benefits.
Without private insurance coverage, doula care remains out of reach for many.
More states should consider and enact policies that would require private insurance plans to cover doula care. While several states are now providing Medicaid coverage for doula care, Medicaid enrollees are not the only population that benefit from doula care. Moreover, addressing racial disparities in maternal care, particularly among Black pregnant and postpartum people, requires action across income levels. A recent study found that maternal and infant health mortality rates remain disproportionately high even among wealthy Black families.
Insurance coverage for doula care is necessary to ensure that all pregnant and postpartum people who want a doula can access one. Currently, most doula services are paid for out-of-pocket, with costs often reaching upwards of $1,500 per birth. Such costs pose a barrier for people with limited financial resources, leaving those who would most benefit from doula care without access. As of 2015, only six percent of birthing people received doula care, and many report desiring but not having access to doula care.
Moreover, doula care is cost-effective, meaning insurance plans can cover doula care without incurring extra expenses. This is why some employers—such as CVS Health and Microsoft—are already offering doula coverage to their employees; more employers should follow suit.
Private coverage of doula care can help ensure that people have access to the support they need during and after pregnancy. As the evidence supporting the benefits of doula care continues to grow, lawmakers and advocates should ensure private insurance plans keep pace
*Kate Rohde was an intern at NHeLP in spring 2023.
For more information about the National Health Law Program’s work on Medicaid coverage for doula care, please see our Doula Medicaid Project page.