Medicaid Reimbursement for Doula Care: Policy Considerations From a Scoping Review

Abstract

Evidence suggests that perinatal doula care can support maternal health and reduce racial inequities among low-income pregnant and postpartum people, prompting growing interest by state Medicaid agencies to reimburse for doula services. Emerging peer-reviewed and gray literature document factors facilitating or impeding that reimbursement. We conducted a scoping review of that literature (2012–2022) to distill key policy considerations for policymakers and advocates in the inclusion of doula care as a Medicaid-covered benefit. Fifty-three reports met the inclusion criteria. Most (53%) were published in 2021 or 2022. Their stated objectives were advocating for expanded access to doula care (17%), describing barriers to policy implementation, and/or offering recommendations to overcome the barriers (17%). A primary policy consideration among states was prioritizing partnership with doulas and doula advocates to inform robust and equitable policymaking to sustain the doula profession.

Access to perinatal doula services in Medicaid: a case analysis of 2 states

“…They represent an investment in partnerships among policymakers, between policymakers and doulas, and between doulas and doula care advocates. 5 , 8 , 13 , 18 , 20 , 22 , 34-40 In Massachusetts, the Department of Public Health's Doula Partner Advisory Group convenes monthly to discuss ongoing legislative efforts, as well as doula–health care facility partnership and doula workforce strengthening. California stakeholders held similar meetings prior to implementation of their state's policy, and continue to hold their legislatively required Doula Implementation Workgroup.…”

“…However, our findings are consistent with the research and policy literature and current national debates surrounding the integration of doula care in health care. 20 States may refer to existing resources 48 as they consider the various components of state support for community doula services. In addition, in an effort to focus this study on key policy informant perspectives, we did not interview PPP and birthing families; their perspective and partnership in any state's doula care policymaking process are urgently needed.…”

“…A recent scoping review by our research team identified 5 key policy issues related to the implementation of Medicaid reimbursement for doula services: increasing doula workforce diversity, reducing administrative barriers to doulas' service provision, determining the value of doula services and facilitating adequate compensation, developing sustainable funding models, and strengthening partnerships between policymakers and the doula community. 20 Resolving these issues is integral to implementing and sustaining Medicaid reimbursement for doula care but is complicated by the exigencies of policymaking in each state. To understand how the policy issues identified in the scoping review are playing out, we examined the implementation of Medicaid reimbursement for doula services in 2 states: Oregon, the state with the longest-standing Medicaid reimbursement policy, and Massachusetts, where, at the time of writing, a policy was about to be implemented.…”