State Momentum on Medicaid Doula Coverage, Rate Increases

Doula care continues to be a hot topic as our nation struggles to address the current maternal and infant health crises. Research has shown that doulas help reduce the risk of adverse birth outcomes, reduce infant mortality rates and help improve perinatal mental health. Access to doula care services can be out of reach for many low-income families who may not have the funds to pay for doula care. That’s where Medicaid comes in. A range of national groups, including the National Health Law Program (NHeLP), National Academy for State Health Policy, Institute for Medicaid Innovation, and National Association for Medicaid Directors have promoted state progress on doula reimbursements in Medicaid as one tool to help address the persistent maternal mortality crisis. (I encourage you to check out the excellent resources NHeLP has shared through their Doula Medicaid Project.)

NHeLP’s most recent tracker, adapted in the map below, details the 43 states and D.C. that have taken steps toward Medicaid coverage for doula care. Looking at the change from 2022 to 2024, state actions toward allowing Medicaid reimbursement of doula care has improved drastically. Only 21 states had even proposed action, were in the process of implementing active reimbursement, or were actively reimbursing for doula care in 2022. That’s a huge momentum shift in two years.

Medicaid is a natural place to look for change as the largest payor of births in the United States. Black, American Indian, and Alaska Native women are at an increased risk of maternal mortality and severe maternal morbidity. These groups are also disproportionately covered by Medicaid based on their economic disadvantage. Community-based doulas offer a research-based strategy to support healthy births, parent-child bonding and early child development. Community-based doulas also have potential to address health equity by supporting pregnant women who may delay needed support or care out of fear or mistrust the health care system.

Our previous blog series on doulas discussed early lessons that can be learned from states who first implemented doula care in Medicaid. Administrative burdens and equitable reimbursement rates continue to be barriers to ensuring access to doula care even when coverage is available, but states are also doing more to address these barriers. Last month, legislators in Washington state passed a budget that will increase the reimbursement rate for state-certified doulas to $3,500 per birth, making it the highest rate in the country once implemented. Additional funds were dedicated to infrastructure support through a doula hub and referral system.

Setting sufficient reimbursement rates is key to encouraging more doulas to become Medicaid providers and allowing greater access to doula services for people enrolled in Medicaid. For states that are actively reimbursing, the reimbursement rates vary from $450-$3,000+ per delivery.

While doulas are an important tool to help combat the maternal health crisis, doulas alone should not be considered a one-size-fits all solution. Policymakers need a multi-faceted toolbox of solutions to bring about improvements in maternal health outcomes, but a robust Medicaid-funded doula provider network is an important step in that direction.

Acknowledgement: We are aware that the word “doula” originally comes from a Greek work for “female servant” or “female slave.” The term “doula” has evolved to represent trained professionals that provide non-clinical support to pregnant persons during the perinatal period. We use “doula” with the framing that NHeLP has explained in the Doula Medicaid Project Framing and Language brief. 

​​Editor’s note: To maintain accuracy, Georgetown CCF uses the term “women” when referencing statute, regulations, research, or other data sources that use the term “women” to define or count people who are pregnant or give birth. Where possible, we use more inclusive terms in recognition that not all individuals who become pregnant and give birth identify as women.

Tanesha Mondestin is a Research Associate at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.