Updated April 16, 2024
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 April 16, 2024. Please contact Anoosha Hasan (ahasan@nashp.org) with updates or questions. You can also download a PDF of this chart.
| State | Federal Medicaid Authority | Training and/or Licensing Requirements | Reimbursement Structure | Billing Procedures |
|---|---|---|---|---|
| California | Effective Date: January 1, 2023 Benefit Category: Preventive Services and Freestanding Birth Center (as a professional service) | Obtain a National Provider Identifier (NPI) Submit a Provider Application for Validation and Enrollment (PAVE) electronic application to enroll in the Medi-Cal program Doulas can enroll through the Training Pathway or the Experience Pathway:
| Fee-for-service
| Doulas may:
Doulas must receive a written recommendation from a physician or other licensed practitioner |
| Maryland | Effective Date: January 1, 2022 Benefit Category: Preventive Service | Must be enrolled with Maryland Medicaid’s electronic Provider Revalidation and Enrollment Portal (ePREP) as a fee-for-service Medicaid provider Attest to being trained and certified by a Maryland Medicaid approved organization Have adequate liability insurance | Fee-for-service
| Doulas may:
|
| Massachusetts | Effective Date: December 8, 2023 Benefit Category: Preventive Services | In-state Providers:
Out-of-state Providers:
| Fee-for-service
For MassHealth providers of doula services, the payment for perinatal visits will not exceed $800 per perinatal period per member, with the exception of payment for additional perinatal visits for which a provider receives prior authorization The perinatal period encompasses pregnancy, labor and delivery, and through 12 months following delivery, inclusive of all pregnancy outcomes. | Doulas may:
Doulas must receive a recommendation from a physician or other licensed practitioner |
| Michigan | Effective Date: January 1, 2023 Benefit Category: Preventive Service | Complete a doula training program by an organization approved by the Michigan Department of Health and Human Services (MDHHS) Register with the MDHHS Doula Registry Enroll as a Medicaid provider by:
| Fee-for-service and Managed Care Organizations dependent on beneficiary enrollment A maximum of six total visits during the prenatal and postpartum periods and one visit for labor and delivery are eligible for reimbursement
All prenatal and postpartum visits must be at least 20 minutes long to be eligible for reimbursement Additional visits can be requested through the existing Medicaid program prior authorization process | Doulas may:
|
| Minnesota | Effective Date: April 1, 2022 Benefit Category: Preventive Service | Complete a state-approved doula training Register on the state’s doula registry (requires an application and fee) | Fee-for-service The reimbursement rate for up to seven sessions, including labor and delivery is:
| Doulas may practice or bill independently Doulas must be recommended by a licensed practitioner. |
| Nevada | Effective Date: April 1, 2022 Benefit Category: Preventive Service | Must have approved doula certification from the Nevada Certification Board Enroll as an individual Nevada Medicaid Provider Type (PT) 90 | Fee-for-service The reimbursement rate is:
Up to 2 additional doula services may be reimbursed when the pregnant person has obtained the following services from a health care professional:
Medicaid Managed Care Organization (MCO)
| Doulas may: |
| New Jersey | Effective Date: January 1, 2021 Benefit Category: Preventive Service | Complete a state-approved doula training and requirements Enroll as a Medicaid provider | Fee-for-service The reimbursement rate is:
$100 value-based incentive payment if the doula performs at least one postpartum service visit and the client is seen by an obstetric clinician for a postpartum visit after a labor and delivery claim. | Doulas may:
|
| New York | Effective Date: January 1, 2024 Benefit Category: Other Diagnostic, Screening, Preventive, and Rehabilitative Services | Enroll as a New York State (NYS) Medicaid doula service provider Obtain a National Provider Identifier (NPI) Meet defined training or work experience pathway requirements The training requirements pathway will include a minimum of 24 hours of training in doula competencies, and doula support provided at a minimum of three births. The work experience pathway will include having provided doula support at a minimum of 30 births or 1000 hours of doula experience within the last 10 years, and testimonials of doula skills. All doulas will be required to revalidate as NYS Medicaid providers every five years and demonstrate completion of continuing education in doula competencies upon revalidation. | Fee-for-service
NYS Medicaid Members are eligible for doula services up to 12 months after the end of pregnancy, regardless of pregnancy outcome. | Doulas may:
Medicaid-enrolled doulas must obtain a written recommendation from a physician or other licensed practitioner |
| Oklahoma | Effective Date: July 1, 2023 Benefit Category: Preventive Services | Enroll as a SoonerCare contracted provider Obtain a National Provider Identifier (NPI) Use the taxonomy number required by the state Possess one of the following certifications by an organization recognized by the Oklahoma Health Care Authority:
| Fee-for-service
Doula providers will use the appropriate code modifier for all procedure codes. Visits have a minimum duration of 60 minutes and may be conducted in person or via telehealth, but the Labor & Delivery Care visit may not be conducted via telehealth. The doula will work with the beneficiary to determine how many visits will occur during the prenatal period or postpartum period. Prior authorization is required for additional visits, for beneficiaries with extenuating medical circumstances. | Doulas may:
Doula services must be referred by a physician or other licensed practitioner |
| Oregon | 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 | Fee-for-service global payment (except in extenuating circumstances) The reimbursement rate is at the lower of:
| Doulas may:
|
| Rhode Island | Effective Date: July 1, 2021 Benefit Category: Preventive | Enrolled as a Medicaid provider Certified by Rhode Island Certification Board Completed 20 hours of relevant education/training, per RICB requirements | Fee-for-service reimbursement based on pregnancy stage (prenatal, labor/delivery, postpartum) A doula may not receive more than $1,500 per pregnancy
A doula must visit with the member for at least 60 minutes to bill each prenatal/postpartum visit | Doulas may:
In order to submit claims for managed care organization (MCO) members, doulas must enroll as MCO providers. |
| Virginia | 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 | Fee-for-service The reimbursement rate is:
$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:
|
| Washington, DC | Effective Date: October 1, 2022 Benefit Category: Preventive Services | Possess a current certification by a doula training program or organization, approved by the District of Columbia Department of Health Care Finance (DHCF) Enroll as a DHCF provider and receive an NPI and taxonomy number | Fee-for-service A maximum of 12 visits across the perinatal period (before, during, and up to 6 weeks after delivery) and the postpartum period (beginning on the last day of pregnancy and extending through the end of the calendar month in which 180 days after the end of the pregnancy falls) The 12 visits include a maximum of one doula consultation and can be allocated across the perinatal and postpartum period
An additional value-based incentive payment of $100 will be made if the doula performs at least one postpartum service visit and the client is seen by an obstetric clinician for one postpartum visit 7 to 84 days after a labor and delivery claim | Doulas may:
|
Acknowledgements: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. 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 U.S. Government.
