NASHP

State Medicaid Approaches to Doula Service Benefits

January 3, 2022 / by Taylor Platt and Veronnica Thompson

Maternal mortality rates continue to increase in the United States, with significant racial, ethnic, and socioeconomic disparities in birth outcomes. States are using a variety of approaches to provide doula services within their Medicaid programs to address inequities.

Doulas provide continuous physical, emotional, and information support to people before, during, and shortly after childbirth. Current evidence suggests that pregnant people who receive doula care are more likely to have a healthy birth outcome and a positive birth experience. Because of these improved outcomes there is the potential for cost-savings over time for state Medicaid programs. States are increasingly seeking federal authorization to provide doula services as an optional benefit under their state Medicaid programs to pregnant beneficiaries.

This chart highlights key components and features of states’ Medicaid doula benefits as of January 3, 2022. Please contact Taylor Platt (tplatt@nashp.org) with updates or questions.

State Federal Medicaid Authority Training and/or Licensing Requirements Reimbursement Structure Billing Procedures
Minnesota State Plan Amendment

• Effective Date: July 1, 2014

• Benefit Category: Extended Service

• Complete a state-approved doula training

Register on the state’s doula registry (requires an application and fee)

• Fee-for-service (FFS)

• The reimbursement rate is:

o $47 per prenatal or postpartum visit and $488 for labor and delivery; and

o Covers up to seven sessions, including labor and delivery

• Doulas may not practice or bill independently

• A supervising physician, nurse practitioner, or certified nurse midwife must bill and supervise all doula services

New Jersey State Plan Amendment

• Effective Date: January 1, 2021

• Benefit Category: Preventive Service

• Complete a state-approved doula training and requirements

• Enroll as a Medicaid provider

• FFS

• The reimbursement rate is:

o $900 for up to eight visits and labor support (standard doula care);

o $1,166 for up to 12 service visits and labor support (enhanced doula care for pregnant beneficiaries age 19 or younger); and

o  Includes $235 flat rate for attendance during delivery

• $100 value-based incentive payment if specific postpartum services provided within six weeks of delivery

• Doulas may:

o Practice and bill independently; OR

o Join a provider agency or clinic and bill independently; OR

o Enroll as a managed care organization (MCO) provider

Oregon State Plan Amendment

• Effective Date: May 1, 2017

• Benefit Category: Preventive Service

• Complete a state-approved doula training and requirements

• Register on the state’s doula registry (requires an application)

• Obtain certification as a Traditional Health Worker (requires an application)

• Enroll as a Medicaid provider

• Global payment (except in extenuating circumstances)

• The reimbursement rate is either:

o    A $350 global payment for a package including at least two prenatal visits and two postnatal visits and labor support; OR

o $50 per visit for up to four maternity visits and $150 for labor support, if the doula cannot complete the global package

• Doulas may:

o Practice and bill independently; OR

o Work with an organization or clinic that bills on their behalf

• A licensed obstetric provider must request the services

Virginia State Plan Amendment

• Effective Date: January 1, 2022

• Benefit Category: Preventive Service

• Complete doula training, which must include core competencies (perinatal support services, labor support), community-based/cultural competency training, and care coordination. Doula trainings must be approved by the Virginia Department of Health (VDH)

• Be certified by an entity designated by VDH

• Enroll as a Medicaid provider

• FFS

• The reimbursement rate is:

o $859 for up to 8 prenatal/postpartum visits and labor support

• $50 value-based incentive payment if the doula performs at least one postpartum service visit and the client is seen by an obstetric clinician for one postpartum visit after a labor and delivery claim

• $50 value-based incentive payment will be made if the doula performs at least one postpartum service visit (this may be the same postpartum visit used for the first value-based payment) and the newborn is seen by a pediatric clinician for one visit after a labor and delivery claim

• Doulas may:

o Practice and bill independently; OR

o Join a provider agency or clinic and bill independently; OR

o Enroll as a MCO provider

Acknowledgments: This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC31658; $398,953. This information, content, and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.

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