Doula Services in Medicaid: State Progress in 2022

During last April’s Black Maternal Health Week, hosted by Black Mammas Alliance, policymakers, advocates, and community members came together to shed light and share policy solutions to combat the current maternal health crisis greatly affecting Black and brown birthing people in the US, which only worsened with the pandemic. The most recent CDC data shows an overall increase in maternal mortality rates. Black and brown birthing people are up to three times more likely to die from pregnancy-related complications, experience severe maternal morbidity at higher rates than their white counterparts, and are more likely to experience mistreatment by health care providers during childbirth.

Doula services were repeatedly highlighted during Black Maternal Health Week as a potential strategy to alleviate the maternal health crisis that disproportionally affects Black and Brown women. While no single policy can solve the crisis, doula services can provide great value to Medicaid programs and beneficiaries. Doula care has not only been linked to lower Medicaid costs, it has also been shown to improve the birthing experience and birth-related outcomes of birthing people of color in underserved communities. Most importantly, doula services can help address current racial disparities in care by providing ongoing culturally congruent tailored care, education, and social, physical, and emotional support.

At least 17 states are in various stages of consideration, planning, or implementation of Medicaid doula reimbursements. According to NHeLP’s Doula Medicaid Project and recent blog, and CCF analysis:

Although there are different avenues states can take to implement doula programs in Medicaid, most states have opted to secure a state plan amendment (SPA) approval from CMS through the preventive services benefit option opened up by the Affordable Care Act.

Our final blog in this series will explore state payment rates for doulas – stay tuned!