Doulas are non-clinical trained professionals who can provide emotional, physical, and informational support and guidance during the prenatal, birth, and postpartum period. Research shows that Black and American Indian and Alaska Native women experience higher rates of severe maternal morbidity and mortality than white women, irrespective of income. Doulas can play a role in improving maternity care and addressing inequities in maternal and infant health outcomes. To understand how state Medicaid programs have designed doula coverage, MACPAC contracted with the Center for Health Care Strategies to conduct a document review and key informant interviews in five states (Florida, Minnesota, New Jersey, Oregon, and Rhode Island) that have implemented the benefit. The interviews were designed to identify the key considerations for providing doula services in Medicaid and to assess whether states included doulas and beneficiaries in designing and implementing the benefit.
The Medicaid landscape for doulas is quickly evolving as additional states adopt this benefit and as states make changes to existing policies. This brief highlights the challenges of incorporating this non-clinical service into Medicaid, as well as the assistance doulas need to support beneficiaries. Officials from the five study states report that doula coverage is an important intervention to improve maternal health. Some states and doula advocates are exploring ways to increase utilization, including efforts to publicize the availability of the benefit and to build the doula workforce.