The U.S. has the highest maternal mortality rate among high-income countries and over 80% of maternal deaths are preventable. Birth outcomes are even worse for Black women, who are three to four times more likely to die from pregnancy-related complications compared to white women. Over the past decade or so, doulas have become an increasingly popular topic of discussion in states as a tool to help improve maternal health outcomes. State lawmakers have introduced and passed many bills requiring coverage for doula care in both public and private health insurance plans.
What are doulas? Doulas provide non-clinical support care to pregnant women during the prenatal, pregnancy, labor, and postpartum periods. They are trained to provide physical, emotional, and informational support. Some doulas specialize in providing birth support for women with high-risk pregnancies and bereavement. Research has shown that community-based doulas may improve birth outcomes by helping to reduce the rate of cesarean sections, preterm birth, and perinatal mental health. Community-based doulas not only improve health outcomes for moms and babies, but may also be cost-effective.
Access to doula care services can be difficult for families with low socioeconomic status where hiring a doula would be a huge financial burden. That’s where Medicaid comes in. Medicaid covers 40% of all births in the U.S. 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. It is also a way for doulas to be able to serve the community and earn an income as well. To learn more about doulas, please take a look at the excellent resources NHeLP has shared through their Doula Medicaid Project.
NHeLP’s most recent tracker detailing the 46 states and D.C. that have taken steps toward Medicaid coverage for doula care. Between 2022 and 2025, the number of states moving forward on allowing Medicaid reimbursement of doula care has significantly increased. CCF will continue to track state progress toward allowing doulas to be reimbursed for their support services through Medicaid and update the map on a regular basis. (Last updated May 2025).
For more information about maternal and infant health, visit this resource page.