Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health

Abstract

Continuous labor support by a trained doula has proven benefits and is recognized as an effective strategy to improve maternal and infant health, enhance engagement and satisfaction with maternity care, and reduce spending. Community-based doula programs can also reduce or eliminate health disparities by providing support to women most at risk for poor outcomes. The most effective way to increase use of this evidence-based service would be to eliminate cost barriers. Key recommendations identify numerous pathways to pursue Medicaid and private insurance coverage of doula care. This comprehensive and up-to-date inventory of reimbursement options provides the doula, childbirth, and quality communities, as well as policy makers, with many approaches to increasing access to this high-value form of care.

Ensuring Racial Equity in Pregnancy Care During the COVID-19 Pandemic and Beyond

“…Policymakers can facilitate such connections by reimbursing professional labor support. Although Medicaid reimbursement of doula services has demonstrated better maternal-infant outcomes and potential for cost savings in the United States, only two states have passed legislation for Medicaid reimbursement of doula services (Kozhimannil et al, 2013 ; Strauss et al, 2016 ). Adopting this policy nationwide has the potential to prevent excessive costs, and promote maternal wellbeing, amid unprecedented and unpredictable times.…”

Barriers and Facilitators to the Implementation of a Community Doula Program for Black and Pacific Islander Pregnant People in San Francisco: Findings from a Partnered Process Evaluation

“…Research also suggests that doula care can lead to higher rates of breastfeeding initiation (Gruber et al, 2013 ; Hans et al, 2018 ; Kozhimannil, Attanasio, et al, 2013 ; Kozhimannil, Johnson, et al, 2013 ; Mottl-Santiago et al, 2008 ), safe sleep and car seat safety practices (Hans et al, 2018 ), attending childbirth classes (Hans et al, 2018 ), and utilization of non-medical pain management during childbirth (Kozhimannil et al, Kozhimannil, Attanasio, et al, 2013 ). Potential cost-savings are associated with doula-assisted births as a result of the lower rates of costly outcomes (Chapple et al, 2013 ; Kozhimannil et al, 2016 ), prompting a commentary advocating for health insurance coverage of doula services, particularly for low-income women (Strauss et al, 2016 ). In light of the ongoing maternal health crisis, policymakers across the country are considering expanding access to doula services (Patel & Chen, 2020 ).…”

The Birth Sisters Program: A Model of Hospital-Based Doula Support to Promote Health Equity

“…Th ere are multiple reasons for this, including lack of knowledge about the benefi ts of doula support among maternity care stakeholders, lack of standardized state-level training and certifi cation, and lack of reimbursement mechanisms. 31,44 Families who can aff ord it may contract with a private doula for a fee. Currently Oregon and Minnesota Medicaid programs reimburse doulas on a fee-for-service basis.…”

“…45 However, low Medicaid reimbursement rates that do not cover the cost of providing doula care, as well as cumbersome regulations that require doulas to be paid through a clinical provider, have been barriers to increasing doula support for low-income people. 31,44,45 Recommendations for alternative funding mechanisms include incorporating doula services into managed care organization bundled maternity care payments, as well as employing doulas as part of a value-based strategy to improve quality and reduce the cost of care. 31,[44][45] Over the last few years, more than 20 federal and state-level bills have been introduced to cover doula services for low-income women.…”

“…31,44,45 Recommendations for alternative funding mechanisms include incorporating doula services into managed care organization bundled maternity care payments, as well as employing doulas as part of a value-based strategy to improve quality and reduce the cost of care. 31,[44][45] Over the last few years, more than 20 federal and state-level bills have been introduced to cover doula services for low-income women. 45 A wide variety of models have been proposed, including a range of funding levels, certifi cation and training requirements, and included services.…”